1) Carpal tunnel syndrome is caused by median nerve entrapment in the carpal tunnel due to thickening of the transverse carpal ligament. 2) Conservative treatments include NSAIDs, night splints, activity modification, and steroid injections. Surgical options are open release, mini-open release, and endoscopic release. 3) The mini-open carpal tunnel release technique has advantages of being less invasive, requiring a shorter operative time and lower complication rates compared to open release, while providing comparable results and patient satisfaction as other techniques in the long run.

1. Carpal Tunnel Release
DrSeeyanShah
PGResident,
DepttofOrthopaedics,
GMCSrinagar.

2. Introduction:

3. • Carpal tunnel is formed between carpal bones of wrist & transverse
carpal ligament (flexor retinaculum)
• Approx. 3cm in size in proximal to
distal direction.
• In saggital plane : thickest in the
Middle (~1.6mm)

5. Median nerve : approx 6mm wide at proximal margin
7.7mm at distal margin
* lies slightly to the radial side of canal
* can be more ulnar : in case of tumor, ganglion , synovitis.

6. Carpal tunnel syndrome:
* Entrapment of median nerve within the carpal tunnel
* Numbness , paraesthesias , pain in the median nerve distribution
* weakness, & muscle wasting.

7. Signs:

9. Diagnosis of CTS to be established by:
1. SYMPTOMS :
*H/O recurrent or persistent pain / paraesthesias in the median
nerve distribution.
*Worsening of symptoms with hand activity
*Nocturnal awakening with paraesthesias
2. SIGNS: positive tinel/phalen/compression sign.
3. ELECTRODIAGNOSTIC tests: NCS/EMG

10. Management:
*CONSERVATIVE:NSAIDS,
night splints,
activity modifications,
steroid injections
*SURGICAL: Open (large incision)
Mini open
Endoscopic

11. Large incision open method:
• By Dr Phalen in 1950
• Effective but had flaws
• Painful and hypertrophic scars
• Pain in thenar and hypothenar eminences

16. Endoscopic Release:

18. Mini open:
• Less invasive
• Shorter operative time
• Lesser complication rate
* bleeding , pain , tenderness , scar sensitivity , stiffness etc.
* better appearance
* Quick recovery
* good patient satisfaction

19. Surgical technique:
* local anasthesia
* tourniquet
*Wrist extended to 30°
approx.
*incision line(fig.)
*define the distal ulnar
border of flexor
retinaculum.

21. Instruments used

26. • * look for ulnar artery curling around hook of hamate, common
sensory branch of ulnar nerve to ring/little fingers, and the ramus
communicans.
• Once clearly identified, the distal ulnar edge of flexor retinaculum is
incised for approx 1 cm

31. • Surgical treatment of CTS shows satisfactory results with all 3
techniques.
• Endoscopic and mini open techniques have less pain and greater
patient satisfaction in the first weeks .
• However, overall results are same and satisfactory with all 3 methods
after 4 months.

32. Thank You