Endoscopic Carpal Tunnel Release
Dr. Woloszyn and the Hand Treatment Center are experts in the minimally invasive endoscopic treatment for carpal tunnel syndrome. (Brown Procedure) Performed as an ambulatory surgery procedure in just a few minutes. Anesthesia is similar to sedation that would be required for a colonoscopy or a tooth extraction. Postoperatively most patients don’t even require any pain medication other than Tylenol or Motrin. Some patients report that the night of surgery is the best night’s sleep they have had in a long time especially if they have been waking at night with radiating pain and numbness as a result of their pinched median nerve causing carpal tunnel syndrome.
Surgeons view of a left Endoscopic Carpal Tunnel Release procedure. Incisions are marked out indicating the proximal and distal portals. The dotted line is the Palmaris Longus (PL) Tendon, if present.
The proximal portal incision is marked out as a one cm. transverse incision just ulnar to the PL tendon within one to two cm’s of the distal wrist crease. A distal portal incision is marked at 3 and 4 cm’s distal to the distal wrist crease in line with the 3rd web space.
The distal edge of the ligament is determined by feeling the elevator enter a more superficial plane and the distal end of the ligament. A mental note of the location of the distal end of the ligament is made in reference to the two marking made earlier.
A 4mm 30′ endoscope is inserted through the distal portal and a Q-tip inserted proximally to clean the end of the scope. The undersurface of the ligament is inspected to make certain that transverse orientation of the fibers is noted and that nothing obscures our vision of the entire length of the transverse carpal ligament.
The hook blade is inserted into the proximal portal and advanced to the distal edge of the ligament and the ligament is then divided from a distal to proximal direction under direct vision of the endoscope. The ligament is visualized as it is divided and widely separated any additional restricting fibers are released as well.
The soft tissues are elevated off of the volar forearm fascia proximally, isolating it from the superficial and deeper structures and divided proximally under direct vision to prevent a secondary site of compression.
Pressure is maintained on the wounds and the tourniquet is deflated. Xeroform gauze and a dry sterile dressing is applied, secured with a cling or Kerlix and a volar forearm splint applied keeping the wrist in neutral position and secured with an ace bandage.