Endoscopic Carpal Tunnel Release (ECTR)
Now . . . Done as Scope Procedure!
A complete, permanent "scoped" release of the carpal tunnel is performed at only a few select hand surgery practices nationally. You have researched and found the best! Dr. Ichtertz has performed thousands of these since 1992. This is truly a specialty among specialists. The nerve, arteries and tendons are safely below the scope. Only the tight band (Transverse Carpal Ligament or TCL) that is crushing of the median nerve causing wrist and hand pain is released.
That day you will be telling many others that your suffering has ended! Our patients from many occupations return to their activities in just hours. NO BRACES, NO LARGE SCARS, NO PHYSICAL THERAPY NEEDED. You will be amazed!
History of Endoscopic Carpal Tunnel Release: Endoscopic carpal tunnel release (ECTR) evolved as the ongoing attempts of physicians interested in carpal tunnel syndrome attempted to come up with a definitive solution to a nagging problem that has almost an exclusively surgical endpoint. Regardless of the size of incision traditional open carpal tunnel release (filet-of-wrist) done by an incision in the palm of the hand tends to keep you off of your job or in a diminished capacity for 6 to 12 weeks minimum (see OCTR results). Open carpal tunnel release has been associated with many side effects including sympathetic dystrophy or chronic regional pain syndrome (CRPS), unappealing visible scar, wound separation (dehiscence), pain from damage to the palmar cutaneous nerve, and recurrence (about 1%)
It was only in 1981 that pressure was proven to be the underlying cause of carpal tunnel syndrome by Gelberman et al at UC San Diego. This created a bit of controversy. This study in various forms was repeated internationally and reported by researchers confirming the elevated pressure in the carpal tunnels of patients with carpal tunnel syndrome compared with the pressures in normals of almost zero.
It was determined that nerve damage from entrapment resulted from pressure on nerves with a destructive effect on the myelin sheath of the nerve; i.e. demyelinization occurs in response to pressure over time. Greater pressure results in an abnormality faster and lesser pressure takes longer to affect the nerve.
At the same time, the question continued as to what could be done to minimize the pressure in the carpal tunnel or the development of the elevated pressure; i.e. what was causing the elevated pressure in the first place.
In 1986, Dr. Ikira Okutsu took a group of patients with classical symptoms of carpal tunnel syndrome, confirmed their diagnosis with electrodiagnostic studies, inserted a pressure transducer into the carpal tunnels of these individuals and then, using a fairly large incision above the wrist, reached into the wrist visualizing with an arthroscope and inserted a small knife allowing him to cut the transverse carpal ligament (TCL) compressing the median nerve. He then re-measured the pressure in the carpal tunnels and he reevaluated the patients. He noted after surgery that their symptoms promptly resolved, the pressure was confirmed to have been relieved by pressure measurements, and the patients did very well. In a follow-up study, Dr. Okutsu reported that additional tissue needed to be released in a large percentage of the patients at the time of the surgery in order to be certain that adequate decompression of the carpal tunnel had occurred. This subsequent research went largely unnoticed by the majority of the surgical community.
During carpal tunnel release surgery, the pressure is released from the carpal tunnel as proven in postoperative pressure measurements. This correlates with elimination of symptoms. Symptom relief is noted immediately in those patients who were awakening at night because of numb or painful hands. Pressure effects on the nerve have been proven in multiple research settings using laboratory animals (Lundgren, Gelberman et al, Ochoa, etc.).
Subsequently in the United States, additional variations in endoscopic techniques were made such as the "Inside Job" by Dr. Agee, the 2-portal Chow endoscopic carpal tunnel release, the 2-portal Brown endoscopic carpal tunnel release and the retrograde 2-portal endoscopic carpal tunnel release, as well as the Carposcopic endoscopic carpal tunnel release.
Though Laser has gotten a lot of press, it's just a hot knife and really has no place in endoscopic carpal tunnel release.
It has been determined that carpal tunnel volume increases about 25% after carpal tunnel release surgery. Click here to learn more about Diagnostic Nerve Testing needed to determine CTS.
|
