Yale Bulletin and Calendar

March 3, 2000

Volume 28, Number 23

Yale surgeon is using a new, less-invasive
treatment for easing carpal tunnel syndrome

A new surgical treatment for carpal tunnel syndrome that improves recovery time and reduces the number of complications from current treatments is being used by Yale surgeon, Dr. Grant Thomson.

The single-portal endoscopic release treatment involves fewer hand incisions and causes less early pain and tenderness because it avoids a second incision within the palm. This new treatment is performed in the Yale Hand and Comprehensive Microsurgery Center using the MicoAire Carpal Tunnel Release system.

The conventional surgical treatment for carpal tunnel syndrome is still in use by a majority of surgeons, Thomson says, but he is among a growing group of surgeons to regularly use the new technique.

"The surgery is performed under local anesthesia and the patient can go home immediately without staying in the recovery room because no sedation is necessary," says Thomson, associate professor of plastic surgery at the School of Medicine. "This makes it less expensive for both patients and employers."

Carpal tunnel syndrome is the most commonly reported nerve problem in the United States. People with the condition experience numbness and pain caused by compression of the median nerve in the wrist. It has been linked to many factors, including trauma, pregnancy, rheumatoid arthritis, diabetes and repetitive motion; however, there is no identifiable cause in many patients.

In mild cases, treatment is not necessary, but surgical release is the only effective treatment in many patients with moderate or severe symptoms. Conventional open carpal tunnel release has a long and successful history, but complications have been reported including painful scars, persistent symptoms and nerve injuries. Even when completely successful, the length of disability and the extended recovery time after open carpal tunnel release may be very expensive for patients and employers.

Traditional treatment involves a longitudinal incision placed within the palm of the hand, and the carpal tunnel is released under direct vision through this incision.

There are several techniques of endoscopic carpal tunnel release using equipment from different manufacturers. These can be classified into two main categories: Two-portal endoscopic carpal tunnel release, and single-portal endoscopic carpal tunnel release.

Single-portal endoscopic carpal tunnel release involves a small incision placed transversely at the wrist level, the incision does not extend into the sensitive skin of the palm, and the carpal tunnel is released by introducing an endoscope into this small incision. The skin and soft tissues overlying the carpal tunnel are therefore not disturbed.

Endoscopic carpal tunnel release has been reported to produce less early postoperative pain and tenderness (within the first three weeks), a more rapid recovery of strength, earlier return to work (nearly 50% in some studies), and reduced disability time.

Studies indicate that complication rates are similar to those following open release.

-- By Karen Peart

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