Endoscopic Carpal Tunnel Release

Transcript

Welcome And Surgical Goal

SPEAKER_00 0:04

Welcome back to the Hand to Shoulder Solution where pain meets its match. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist. I'm here today to demonstrate endoscopic carpal tunnel release on a model. And on the model, I want to show you what the surgeons do when they do a very small incision and an endoscope or a tool to go underneath a thick, heavy ligament that forms the roof of the carpal tunnel, which is called the transverse carpal ligament or the flexor retinaculum. And instead of doing a large incision and opening up the whole way through from the absolute top or the surface, it's a lot better for recovery, for a quicker recovery, to make a small incision, travel underneath that transverse carpal ligament, and then pull a blade back to release the ligament and release the pressure on the nerve. So this is called a carpal tunnel release surgery because it's releasing pressure from the nerve. And I invite you to watch past episodes where I present carpal tunnel syndrome, what it is, how to handle it, what we do for conservative treatment instead of surgery, and then also what's done in surgery and post-operative therapy when post-operative therapy is needed. So let's look at the tool. This is a partial tool. I taped a flashlight on the end. Normally, what there is is there's a very bright light, there's a scope or a camera, and there's a long metal rod with an extremely bright light at the end with a camera lens that goes down through here, and the camera lens can be placed inside of the incision and then travel underneath that thick, heavy ligament. And then with the camera, the surgeon can view where the nerve is, where the tendons are, and ensure that they're in the right position before they do any cutting. And that's very important. They need to visualize things internally. Now, once everything is visualized, the surgeon can push this button and raise a little blade and then pull that back, which will cut that thick, heavy ligament that forms the roof of the carpal tunnel. Let's go to this model over here. Now, on this model, you can see the tendons connecting the muscles in the forearm to the bones of the fingertips. So when the muscles of the forearm contract, it pulls the tendons that travel through the carpal tunnel and bends the fingers. The yellow structure is the nerve. There's a median nerve here that plugs into the thumb, the index finger, long finger, and half the ring finger. The ulnar nerve is way over here in Guyane's canal. That's another video as well that I invite you to watch. And that plugs into the small finger and half of the ring finger. But let's go back to the carpal tunnel. So this would travel through underneath here, and underneath the ligament, a blade would pop up, and then the surgeon can pull it back and do the cut, and that's the surgery. Then this portal wound would be sutured closed. I really like this from my perspective as a hand therapist because the recovery is much shorter, there's less scar tissue. Now, I uh made a mock-up of the uh transverse carpal ligament with a piece of paper. So, what I want to do is demonstrate that. So then the surgeon would make out an incision, I'll show you in my hand, just about here, and there's these creases on the wrist on one of the on the crease, like that, and then the tool would be inserted down into the just about a centimeter incision, so very, very small, okay. And it would be travel, it would travel inside of that centimeter incision, the small incision, underneath here. The surgeon would turn it a little bit to view where the where the nerve is, where the median nerve is located, to ensure that that is not going to be uh contacted at all. And then advanced, then the blade would come up, and then as the surgeon pulls it back, the ligament, the transverse carpal ligament is now opened, and that occurs underneath the skin, of course, and that releases the pressure. So now that releases the pressure on the nerve. The nerve lies very shallow to this flexor retinaculum, this thick heavy ligament that forms the roof of the carpal tunnel. So when that is cut and that roof of the carpal tunnel is cut underneath the skin, that relieves the pressure on that nerve, which is quite shallow, which is just under that roof, that ligamentous roof that was just severed. So that literally releases the pressure off the nerve. That's why it's called the carpal tunnel release surgery. And that's why that it is the wrong thing to do to massage this the scar or massage the carpal tunnel. Sometimes this will get swollen, and we have specific techniques to get rid of the swelling and take away postoperative pressure when it's needed. Uh, it's it's very rare that there's any complications after this simple, very relatively non-invasive surgery, but sometimes it occurs when some pain happens on the pinky side and the thumb side called pillar pain, uh, due to some instability of the wrist, also some internal swelling that we can get out of there that we can remove with some special techniques, but not massage, because remember, the whole purpose for the surgery is to relieve pressure off of the nerve. So if we rub that area, then now there's pressure on the nerve, and the symptoms of the carpal tunnel syndrome can come back and come back quite severely. Thank you for watching the Hand to Shoulder Solution, where we are the solution to your pain.