Endoscopic Carpal Tunnel Release (ECTR)
Stitchless Endoscopic Carpal Tunnel Release (SECTR)
- Stitchless 10 minute surgery
- Minimal scarring and pain with 1 cm incision
- Local anesthetic
- No restrictions after 48 hours
- One week recovery
- Indicated as early as 8 weeks after symptom onset to prevent permanent nerve damage
- 50% faster recovery than the “open” procedures
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a painful irritation of the median nerve in the hand and wrist. CTS develops overtime because of repetitive hand motions. The condition can cause pain, numbness or tingling in the hand and fingers.
What is the Carpal Tunnel?
The carpal tunnel is a space between the carpal ligament and the bones at the base of the hand. The tendons that flex the thumb, index and ring finger pass through this space. So does the median nerve, which supplies feeling to the thumb, index and ring finger.
Carpal tunnel syndrome can be treated with rest, bracing, steroid injections or surgery. For those requiring surgery, Stichless Endoscopic Carpal Tunnel Release (SECTR) is performed to relieve pressure on the median nerve, alleviating numbness and tingling in the thumb, index, middle and ring fingers. The endoscopic carpal tunnel technique is performed on an outpatient basis in D.I.S.C.’s state-of-the-art surgical center. The endoscopic approach creates less pain and scarring than traditional open surgery, allowing for a quicker recovery.
Stitchless Endoscopic Carpal Tunnel Release (SECTR) Procedure
1. Preparation: A small incision is created in the wrist.
2. Endoscope Inserted: An endoscope, which the surgeon uses to see inside the wrist and hand, is inserted underneath the transverse carpal ligament. The endoscope has a light and a small video camera that sends images to a TV monitor in the operating room.
3. Ligament Cut: Using the video images from the endoscope as a guide, the surgeon precisely cuts the constricting transvers carpal ligament, relieving pressure on the median nerve.
Note: Through a single, small incision, the ligament is released without having to cut through the skin and muscles of the palm resulting in less pilar pain and less scarring pain.
| SECTR | OPEN PROCEDURE |
|---|---|
| Stitchless | 5-10 sutures |
| 1/4 inch scar | 3 inch scar |
| Little to no scar sensitivity | Tender scar for months, possible permanent |
| Small dressing | Splint for 3 weeks |
| May get dressing wet | Must keep dry for 3 weeks |
| Usually no therapy | 4-8 weeks of therapy |
| Light activities Immediately | Light activities at 3 weeks |
| Return to strenous work at 1 month | Return to strenous work at 3 months |
Dr. Knight Performs SECTR Procedure
SmartRelease Endoscopic Carpal Tunnel Release
Carpal Tunnel Endoscopic Release Testimonial
Causes of Carpal Tunnel Syndrome
Repetitive use of the hand and wrist is a common cause of carpal tunnel syndrome. As the flexor tendons move back and forth through the carpal tunnel during movement of the digits and wrist, the lubricant forming tenosynovium which is lining these tendons within the carpal tunnel, begins to hypertrophy or swell as it tries to limit friction on the tendons. Pressure is placed on the median nerve as there is no room for the extra swelling within the tunnel. As pressure is increased on the nerve, the nerve becomes strangled leading to a loss of its internal circulation causing the classic symptoms of the hand falling asleep.
Another cause of carpal tunnel syndrome are metabolic abnormalities where the body swells and in the case of a tight space such as the carpal tunnel, this swelling is not tolerated causing increased nerve pressure. Common abnormalities that can cause or predispose one to develop carpal tunnel syndrome are diabetes, hypo or hyperthyroid, etc. In addition to the typical treatment of carpal tunnel syndrome, the main treatment for these cases is to make sure the metabolic abnormality is properly treated and controlled.
There are many inflammatory conditions that lead to a buildup of inflammation throughout the body particularly in joints and around tendons. This buildup of extra tissue with the fixed space of the carpal tunnel causes an increase in nerve pressure leading to symptoms of carpal tunnel syndrome. Common inflammatory conditions are Rheumatoid arthritis, Lupus, Gout, etc may lead to the development of carpal tunnel syndrome. In addition to the typical treatment of this condition, the main treatment is to bring this inflammatory condition under control. Frequently this requires the assistance of a rheumatologist who will bring this under control with NSAIDs, steroids and sometimes chemotherapeutic drugs.
Congenital abnormalities may be present which can lead to carpal tunnel syndrome. This occurs in some cases when the canal size is reduced due to a narrowing of the canal through abnormal bone formation at the floor of the tunnel or it may occur through an overcrowding of the contents of the tunnel from abnormal extra muscles that are present.
A common cause of carpal tunnel syndrome is due to a specific trauma from a fall on an outstretched hand and wrist. With significant trauma a fracture of one of the small bones of the wrist, carpal bones, or the forearm bone , radius, or a dislocation of the joints in the wrist can cause excessive bleeding with the carpal tunnel or can cause a malpositioning and stretching of the nerve leading to symptoms of carpal tunnel. In this condition, emergent treatment is necessary by aligning the fracture. If this resolves the carpal tunnel symptoms, then no other treatment is needed. If the symptoms persist or open surgical treatment is needed to stabilize the fracture or dislocation, then the carpal tunnel should be opened to relieve the pressure on the median nerve to prevent permanent damage.
In the treatment of the causes above other than trauma, the goal is to reduce the pressure on the nerve by reducing the offending cause through, splints, medications, injections, ergonomic changes in the work station, rest and decreasing the use of the hand and wrist. If the condition persists, the stitchless endoscopic carpal tunnel release is a highly effective procedure.
Informational Links:
The Hand and Wrist Institute- SECTR Brochure
Single-Portal Endoscopic Carpal Tunnel Release Comparred with Open Release
Service Tags: Carpal Tunnel Release Surgery Los Angeles, Carpal Tunnel Surgery Los Angeles, Carpal Tunnel Release Los Angeles, Carpal Tunnel Surgeon Los Angeles, Carpal Tunnel Release LA, Carpal Tunnel Doctor Los Angeles
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HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer
