POSTED: January 11, 2009

Endoscopic Carpal Tunnel Release (ECTR) Offering Less Post Operative Pain and More Rapid Recovery than Traditional Open Procedure

The carpal tunnel is a narrow passageway bound by bones and ligaments located on the palmar side of the wrist. The tunnel protects the main nerve, known as the median nerve, to the hand and the nine tendons that bend the fingers. Pressure placed on the nerve can produce numbness, pain and weakness. This is referred to as carpal tunnel syndrome (CTS).

Although many believe this is a fairly new ailment brought on by the increased use of computers and other technological devices, there is evidence of CTS dating back to the beginning of the 20th century.

The causes and symptoms vary from patient to patient. It is believed that the repetitive overuse of the hand in wrist in a particular activity leads to the condition, which is why it is categorized as a "repetitive stress" condition among medical professionals. Carpal tunnel syndrome can be a temporary condition that completely resolves on its own in some patients, though in others can persist and progress to a debilitating state requiring surgery.

When repetitive stress results in pressure placed on the median nerve passing through the carpal tunnel, inflammation constricts the space in the already narrow tunnel. Carpal tunnel syndrome can be caused by a variety of factors including: repetitive use or injury; health conditions such as rheumatoid arthritis or diabetes; and physical characteristics such as a carpal tunnel that is more narrow than average and therefore predisposed to the condition.

CTS symptoms may include: weakness in the hands; constant loss of feeling in some fingers; tingling or numbness in the fingers or hand; and pain extending from the wrist up the arm to the shoulder or down into the palm or fingers. Symptoms usually start gradually and often appear during the night since many people sleep with flexed wrists.

Mild symptoms are usually cured through conservative treatment that the patient can do at home. Home treatments may include rehabilitative hand exercises, rest from repetitive activity, ice, wearing a wrist splint and anti-inflammatory medications such as Advil or Ibuprofen, in order to ease pain and reduce inflammation. If symptoms do not get better or if they progressively get worse, the doctor may suggest surgery.

A carpal tunnel release is the most common surgical procedure used to correct carpal tunnel syndrome when symptoms last for six months or more and are nonresponsive to other conservative treatment. The two types of surgeries performed are the traditional open release surgery and a somewhat newer procedure known as endoscopic carpal tunnel release (ECTR).

The primary difference between an open surgery and ECTR procedure are the incisions required. The ECTR requires only two, half-inch incisions in contrast to the much larger incision of the traditional open surgery - usually between two to five inches. ECTR is performed under local anesthesia on an outpatient basis, lasting only 30-45 minutes. A splint is often required for four to five days post surgery, or until the sutures are removed.

With ECTR, a shorter recovery is expected since it does not require a larger cut to the palm, disturbing a large area of the hand. The endoscopic technique preserves the skin and soft tissue of the palm causing less postoperative pain and a more rapid return to activity. Most patients who undergo ECTR are able to resume most of their day to day activities within few days following surgery - often returning to work three to six weeks following surgery. Open surgery usually requires a substantially longer recovery time.

Dr. Evan Collins specializes in degenerative joint conditions and the small bones of the hand, wrist and elbow. If you are suffering from carpal tunnel syndrome and would like to learn more about ECTR log onto or call 713-441-3535 today.