Non-surgical treatments may include behavioural changes such as reducing or eliminating repetitive hand motion, wearing wrist splints at night or receiving anti-inflammatory medication taken orally or injected into the carpal tunnel.
Surgical treatments vary, but the two most common are Open Surgery and Endoscopic Surgery. Both procedures share the goal of easing pressure on the median nerve by surgically cutting the transverse ligament and thereby enlarging the carpal tunnel to make more room for the nerve. Both procedures are effective, but Endoscopic Surgery results in faster recovery time, less post-operative pain and a smaller, less-noticeable scar.1
During Open Surgery, an incision is made from the crease of the wrist toward the centre of the palm, through layers of skin, fat and connective tissue. Once the transverse ligament is exposed, the surgeon cuts the ligament with a blade to release pressure on the nerve. The surgeon then closes the incision with sutures and dresses the hand.
This procedure is effective; but it may not be the best option for some patients because it leaves a scar from the wrist to the centre of the palm; and recovery and rehabilitation can take several weeks due to post-operative pain, the deep cutting of the hand and a longer incision.
During single-portal Endoscopic Surgery, a small incision is made in the crease of the wrist, where the surgeon inserts a small camera mounted to a surgical instrument called a SmartRelease™ ECTR. This device allows the surgeon to see inside the carpal tunnel using a video monitor. The surgeon then precisely cuts the ligament using a retractable blade within the SmartRelease™ ECTR system, without opening the entire palm. Once the ligament is fully released, the blade is retracted, the instrument is withdrawn and the small incision is sutured and dressed.
The guiding principle of this minimally invasive procedure is to minimise post-operative pain by avoiding an open incision extending from the wrist across to the palm. Endoscopic Surgery is highly effective and has been used for more than 20 years. It results in less post-operative pain, a minimal scar concealed by a wrist crease, and generally allows patients to resume some normal activities in a short period of time.1
1 "Single-Portal Endoscopic Carpal Tunnel Release Compared with Open Release"
Trumble TE, Diao E, Abrams RA, Gilbert-Anderson MM The Journal of Bone & Joint Surgery 2002; 84:1107-115