Summary

This paper describes a simple technique of arthroscopic carpal tunnel release without the need for any complex instrumentation with a follow-up case series.

Abstract

Background

Carpal tunnel release (CTR) is a well established procedure for surgical treatment of carpal tunnel syndrome (CTS). The release can be performed using open, mini-open and endoscopic techniques with good results. In this technique note, we describe our initial results using an alternate minimal access technique of arthroscopy assisted carpal tunnel release (ACTR). ACTR does not require any complex or expensive instrumentation compared to other existing minimal access carpal tunnel release techniques.

Methods

Technique: Surgery was performed under regional anaesthesia and tourniquet control. The Kaplan cardinal line and a vertical line along the radial border of the ring finger was drawn to identify the surface anatomy of carpal tunnel. A 1cm transverse skin incision was made over the proximal wrist crease, between the palmaris longus tendon and the flexor carpi ulnaris tendon. Superficial veins were cauterised and the antebrachial fascia was exposed. A small vertical incision was made over the fascia which exposes the layer of fat over the median nerve. The fascial incision was then extended both proximally and distally to insert a 4 mm, 30 degree arthroscope without the sheath in a proximal to distal direction dorsal to the carpal tunnel. A mini (5 mm) Langenbeck retractor was used to retract the distal part of the surgical wound for the arthroscope to pass freely without increasing the pressure on the median nerve. With the arthroscope positioned dorsal to the TCL and the median nerve visually identified, an arthroscopic scissors was inserted under the TCL just ulnar to the arthroscope. The TCL was then carefully released under arthroscopic vision. The distal extent of the release is marked by visualisation of the fat pad at its distal limit marked by the intersection of the Kaplan cardinal line and the vertical line along the radial border of the ring finger. Transillumination by the arthroscopic light at this point also confirms the completeness of the release.
The technique of ACTR was used in 11 patients with symptomatic CTS. To evaluate the results of the procedure, patients were assessed preoperatively, post-surgery at 2, 4, 12 weeks, then at 1 year, 2 years and 4 years using the Boston carpal tunnel syndrome questionnaire (BCTQ). Complications and recurrences were recorded.

Results

Improvement in symptoms was evident in all patients. No intra-operative difficulties, conversion to an open technique or any procedure related complications were recorded. Significant reduction in symptom severity (p < 0.001 ) and improvement in functional status (p = 0.0003) was evident at 2 weeks post-surgery compared to the preoperative BCTQ scores. 8/11 patients returned to their original work by 4 weeks and the remaining 3 patients by 12 weeks. Maintenance of function and no recurrence in symptoms was noted in all patients at 4 years follow up.

Conclusion

ACTR is an effective minimally invasive technique for surgical treatment of carpal tunnel syndrome. The procedure achieves effective decompression of the median nerve providing relief of symptoms and improvement in hand function without serious complications.