Endoscopic

Endoscopic Carpal Endoscopic Carpal Tunnel ReleaseTunnel Release

Dr S.L. CarterDr S.L. Carter

Groote Schuur and Vincent Pallotti Groote Schuur and Vincent Pallotti Hospitals Hospitals

Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release

Introduction - Introduction - 1% population1% population

-- Most common nerve entrapment Most common nerve entrapment

History - History - 1989 Okutsu and Chow1989 Okutsu and Chow

Incidence / Cost Incidence / Cost


Questions ?Questions ?

Is Endoscopic superior to Is Endoscopic superior to openopen

Advantages and Advantages and disadvantagesdisadvantages

Are the risks greaterAre the risks greater Should we be doing ECTRShould we be doing ECTR Which is more cost effective Which is more cost effective What does the patient wantWhat does the patient want Does it workDoes it work

http://images.google.co.za/imgres?imgurl=http://www.hmc.psu.edu/plasticsurgery/aservices/hand/images/endo1.gif&imgrefurl=http://www.hmc.psu.edu/plasticsurgery/aservices/hand/endoscopic.htm&h=1274&w=1799&sz=29&tbnid=CA9mMdPIpb8J:&tbnh=106&tbnw=150&hl=en&start=2&prev=/images%3Fq%3Dendoscopic%2Bcarpal%2Btunnel%26hl%3Den%26lr%3D%26sa%3DG


AdvantagesAdvantages Early return to work ( 14 vs 29 Early return to work ( 14 vs 29

days Agee)days Agee) Less incisional painLess incisional pain No Pillar painNo Pillar pain Improved grip strength ( 6 weeks Improved grip strength ( 6 weeks

vs 3 months)vs 3 months) Improved key pinchImproved key pinch Atraumatic minimally invasiveAtraumatic minimally invasive

DisadvantagesDisadvantages VisualizationVisualization Incomplete releaseIncomplete release Unable to perform Unable to perform

neurolysis or neurolysis or synovectomysynovectomy

Inadvertant Guyons Inadvertant Guyons canal releasecanal release


Does it work?Does it work? Gelberman 1995 Decrease carpal pressuresGelberman 1995 Decrease carpal pressures

Improved nerve conductionsImproved nerve conductions

Peimer 1993 Equivocal canal volume increase withPeimer 1993 Equivocal canal volume increase with

ECTR and open release ( MRI )ECTR and open release ( MRI )


Are the risks greaterAre the risks greater

Nerve injury open 0.16 –0.8%Nerve injury open 0.16 –0.8%

endo 0.1- 1 %endo 0.1- 1 %

Kuschner 1991 3035 hands openKuschner 1991 3035 hands open

Agee Adams 1993 1050 endo Agee Adams 1993 1050 endo

The Risks appear to be Equivocal between the two The Risks appear to be Equivocal between the two techniquestechniques


techniquetechnique


TechniqueTechnique

Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release 250 cases over 8 years250 cases over 8 years

Satisfaction rate high / particularly bilateralSatisfaction rate high / particularly bilateral

No major complications to dateNo major complications to date


Tips and pitfallsTips and pitfalls AnaesthesiaAnaesthesia FoggingFogging Synovial fluidSynovial fluid NB entry pointNB entry point Adequate synovectomyAdequate synovectomy Use 2 handsUse 2 hands Wrist extendedWrist extended Use the tip of the scope as an instrumentUse the tip of the scope as an instrument Fat / Muscle /Fat or FMFFat / Muscle /Fat or FMF


Tips and PitfallsTips and Pitfalls Adequate release- bounce test Adequate release- bounce test

distallydistally Don’t forget proximal releaseDon’t forget proximal release Bulky bandage pressure Bulky bandage pressure

Endoscopic

Healthcare

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