Carpal Tunnel


Introduction

The carpal tunnel is a cavity at the wrist level.

The tunnel is formed by the carpal bones, which are the floor and the walls; as well as the Transverse Carpal Ligament that is the roof. Besides the Median Nerve, veins and tendons of the flexor muscles of the fingers also go through this tunnel.



The Carpal tunnel syndrome is a pathology, where the median nerve is compressed by the Transverse Carpal Ligament; and inflammation causes problems, such as the typical tingling, sharp pain, mainly at night; and fingertip sensitivity, as well as burning and difficulty in holding objects. The most frequent factors are hormonal factors (especially in women) or micro-traumas, due to daily activities, such as the use of the keyboard and the mouse. In the early stages it is possible to treat the disease conservatively through anti-inflammatories, infiltrations and rehabilitation exercises.

Once the symptoms show in an advanced stage, only surgery can solve the problem.


What does surgery consist of?

Surgery consists of releasing the Median Nerve after cutting the Transverse Carpal Ligament, which represents the roof of the carpal tunnel. This is the ligament that presses the nerve and compresses it by causing the typical symptoms of the Carpal Tunnel Syndrome.

Traditional surgery provides an effective solution to the problem, but through a surgical incision of approximately 5-7 cm to cut the Transverse Carpal Ligament completely.



In our Clinic, surgery is carried out through endoscopy with a procedure similar to the arthroscopic knee surgery.

The cutting-edge method used today by Dr. D’Angelo at Clínica Planas (considered as the gold standard in Europe), differs from the traditional technique by the use of a video camera of just 4 mm (endoscopy), which is inserted en a small incision.

Thanks to the endoscope it is possible to reach the ligament where to operate by performing a minimum incision of a few millimetres at the wrist level. The surgeon has a clear and accurate vision of each step.

 

The device allows the surgeon to go through the carpal tunnel and see all the structures more accurately and safely, since the endoscope allows enlarged images as a magnifying glass, using a monitor.

The surgeon cuts the ligament accurately with a retractable blade without cutting the skin, since he works from inside the tunnel. As soon as the ligament is completely released, the blade retracts, the tool is removed and the small incision is sutured. This endoscopic method allows the patient to return to usual daily activities in about 2-3 days.

All this procedure is carried out as an outpatient basis and under local anesthesia.

Surgery is much less invasive than others and lets the patient go back home the same day, and recover the movement of the hand from the day after surgery, without any bandages, and with a simple dressing. In addition to these advantages with the endoscopic technique, stitches do not need to be removed since there is almost no suture.  

Endoscopic surgery is a safe and effective method for the treatment of the carpal tunnel. The Surgery of Hand and Foot Unit of Clínica Planas, which is at the cutting-edge of surgical innovations, at a national and international level, is proposed as the leader centre in minimally invasive surgical treatments for hand and foot pathologies.

ENDOSCOPIC CARPAL TUNNEL - CHARACTERISTICS

The surgical treatment consists of decompressing the nerve through the incision of the Transverse Carpal Ligament.

Post-operative immobilization is NOT necessary, and the patient can return to his/her usual daily activities after 2-3 days.

Moreover, there is NO need of physiotherapy because patients usually recover on their own.



Benefits

The postoperative is faster and less painful, different from the traditional technique that requires a longer recovery time.

Through open surgery, an incision of 5-7 cm is carried out in a sensitive area of the hand. There are many small nerves in the fat tissue, and when they are separated by the incision, make the patient have an uncomfortable sensitivity after surgery. The endoscopic method does not have this problem because the surgeon works from inside the tunnel.

The main advantage of this surgical method, compared to the open method, is that the patient can return to his/her daily life, doing the usual activities at work and at home much sooner than with the traditional technique.

Scientific studies show that in the long term, both types of surgery have the same success rate.



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