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Endoscopic
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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
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
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
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
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
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel 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 )
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
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
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
techniquetechnique
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
TechniqueTechnique
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
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
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
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
Endoscopic Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release
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 Carpal Tunnel ReleaseEndoscopic Carpal Tunnel Release