29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament

Name of the Procedure:

Endoscopy, wrist, surgical, with release of transverse carpal ligament
Common name(s): Endoscopic Carpal Tunnel Release, Carpal Tunnel Surgery

Summary

Endoscopic Carpal Tunnel Release is a minimally invasive surgical procedure used to relieve pressure on the median nerve in the wrist. This is accomplished by cutting the transverse carpal ligament, which helps to ease the symptoms of carpal tunnel syndrome.

Purpose

Medical Condition: Carpal Tunnel Syndrome
Goals: The procedure aims to relieve symptoms such as pain, numbness, and tingling in the hand and fingers. It also seeks to restore hand functionality and prevent further nerve damage.

Indications

• Persistent numbness and tingling in the hand and fingers, especially the thumb, index, and middle fingers.
• Weakness in the hand that affects daily activities.
• Pain that worsens at night.
• Ineffectiveness of conservative treatments like splints, medications, or physical therapy.
• Positive diagnostic tests like nerve conduction studies indicating median nerve compression.

Preparation

• Patients may need to fast for at least 6-8 hours before the procedure.
• Certain medications, especially blood thinners, may need to be adjusted or stopped prior to the surgery.
• Preoperative tests such as a nerve conduction study or electromyography (EMG) may be required.

Procedure Description

1. The patient is given local anesthesia or light sedation.
2. A small incision is made in the wrist.
3. An endoscope (a small camera) is inserted through the incision to provide a view of the transverse carpal ligament.
4. Using specialized instruments, the surgeon cuts the transverse carpal ligament to relieve pressure on the median nerve.
5. The endoscope and instruments are removed, and the incision is closed with sutures.

Tools/Equipment: Endoscope, surgical instruments for cutting the ligament
Anesthesia: Local anesthesia or light sedation

Duration

The procedure typically takes about 20-30 minutes.

Setting

The procedure is usually performed in an outpatient surgery center, hospital, or a specialized surgical clinic.

Personnel

• Surgeon
• Surgical nurse
• Anesthesiologist (if sedation is used)
• Surgical technician

Risks and Complications

• Common risks: Infection, bleeding, and pain at the incision site.
• Rare risks: Nerve damage, incomplete release of the ligament, and scarring.
• Complications management: Infection can be treated with antibiotics, and any surgical complications may require additional interventions.

Benefits

• Significant reduction or complete relief of carpal tunnel symptoms.
• Improved hand functionality.
• Quick recovery time compared to open surgery.
• Many patients notice improvement within days to weeks post-surgery.

Recovery

• Patients can usually go home the same day.
• Keep the hand elevated and avoid heavy use for at least a few days.
• Sutures are typically removed within 1-2 weeks.
• Full recovery and return to normal activities generally take about 4-6 weeks.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Conservative treatments: Wrist splinting, physical therapy, corticosteroid injections.
• Open Carpal Tunnel Release surgery: Larger incision, but also effective.
• Pros and Cons:
  • Conservative treatments have fewer risks but may not provide long-term relief.
  • Open surgery involves a larger incision and longer recovery time but is sometimes preferred for severe cases.

Patient Experience

During the procedure, patients may feel some pressure or pulling sensations but should not feel pain due to anesthesia. Post-procedure, mild pain and swelling are common and can be managed with over-the-counter pain medication and ice. Patients usually experience quick relief from symptoms and can gradually return to normal activities as healing progresses.