Over the last few years a number of articles have appeared in the Atlanta Constitution, the Wall Street Journal and other popular publications on endoscopic carpal tunnel release. The demand for this procedure has grown as more individuals learn about carpal tunnel syndrome and the alternative treatment methods for this disorder. ECTR has become a very popular procedure because it may afford many patients a faster recovery and less pain after surgery.

Endoscopic carpal tunnel release is a very new procedure utilized over the last 2-3 years. About 10,000 ECTRs have been performed. Although this is only a small number to consider, it appears to be a very good procedure. Dr. Weil is one of the instructors in endoscopic carpal tunnel surgery which has now been taught to approximately 600 orthopaedic surgeons, hand surgeons, neurosurgeons and plastic surgeons around the United States. It is not known what percentage of surgeons are actually using this procedure but it is becoming more available as more surgeons learn how to use this device. About 80 percent of carpal tunnel surgery is still being done as an "open" procedure.

Endoscopic carpal tunnel release itself is an operation where a small incision is made in the wrist and in the palm and an endoscope is used to visualize the carpal ligament which is cut with small blades under direct visualization. The difference between ECTR and open carpal tunnel release is that with ECTR there are only two small incisions required. However, with open carpal tunnel procedures, a relatively lengthy incision which is usually between 4 and 8 cms (2" to 5'') is utilized to release the carpal tunnel. By using an endoscopic technique for surgery it is believed that the skin and soft tissue of the palm can be preserved and therefore less post operative pain and more rapid recovery may be possible.

Since this is a new procedure, there is still a great deal that remains to be investigated. It is important to determine whether in the future ECTR will allow for the same results of open carpal tunnel release, which are quite good. It is hoped that ECTR will be as effective as open carpal tunnel surgery and that there will not be a high rate of recurrence of carpal tunnel syndrome following ECTR. The complication rate of ECTR does not appear to be an greater than open carpal tunnel surgery. The complication rate of open carpal tunnel surgery that is often cited is between 12 percent and 25 percent of patients that have some problem following carpal tunnel surgery. Early studies of ECTR show that there is no greater complication rate with this new procedure, and it may actually have less complications.

The surgery itself (ECTR) is performed under local anesthesia ( with additional medication if "Twilight" anesthesia is needed). The operation is performed on an outpatient basis. The operative takes about 30-45 minutes to complete and is done in an operating room. Most patients wear a "post-operative" splint for 4-5 days until sutures are removed. Then, they return to wearing a wrist splint or glove until post operative pain subsides. Some require use of a glove or splint at work.

Perhaps the most impressive part about endoscopic carpal tunnel release is how quickly patients appear to recover from this operation. Although many patients do complain of pain in the palm and some discomfort with the fingers after surgery, most appear to be able to resume most of their day to day activities within a few days after surgery and often return to work 3-6 weeks after surgery. Open surgery with longer incision takes a substantially longer time for recovery. Even with ECTR, many patients are required to avoid heavy lifting and repetitive motion for 6-8 weeks after surgery. The need for therapy is lower due to less swelling and easier use of hand following surgery.



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