Carpal tunnel syndrome surgery

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• Lipomatous Mass Effect on the Brachial Plexus: A Case Report
• Carpal tunnel release surgery restores force control but not force coordination in CTS patients
• Efficacy of dry needling with the fascial winding technique in reducing the percentage of surgery in carpal tunnel syndrome: A randomized clinical trial
• Prospective, Randomized, Intra-subject Controlled Trial Comparing Ultrasound-guided Thread and Mini-open Carpal Tunnel Release
• Trigger finger and carpal tunnel syndrome: a meta-analysis of co-occurrence and risk

Surgical treatment for carpal tunnel syndrome (CTS) is generally indicated when conservative management fails or when there is evidence of significant nerve compromise. Indications include:

Persistent symptoms despite adequate conservative therapy (e.g., splinting, NSAIDs, corticosteroid injections) for at least 6–12 weeks.

Severe or progressive motor weakness, particularly of the thenar muscles (e.g., abductor pollicis brevis).

Electrodiagnostic evidence of moderate to severe median nerve compression at the wrist.

Atrophy of the thenar eminence.

Nocturnal symptoms that severely affect sleep and quality of life.

Failure to respond to local corticosteroid injection or recurrence after initial improvement.

Worsening sensory loss (e.g., two-point discrimination, numbness).

Occupation-related CTS where early return to function is essential.

1. Open Carpal Tunnel Release (OCTR) Description: Traditional technique involving a 3–5 cm incision over the palm to directly visualize and cut the transverse carpal ligament.

Advantages: Direct visualization; lower risk of nerve injury.

Disadvantages: Longer recovery time, more postoperative pain, scar tenderness.

2. Mini-Open Carpal Tunnel Release Description: A smaller incision (1.5–3 cm) than in standard open surgery, sometimes with special tools to minimize soft tissue damage.

Advantages: Less invasive than open; quicker recovery.

Disadvantages: Limited visualization compared to open.

3. Endoscopic Carpal Tunnel Release (ECTR) Description: Uses an endoscope through one or two small incisions (single-portal or dual-portal techniques) to divide the transverse carpal ligament.

Advantages: Faster recovery, less postoperative pain, better cosmetic results.

Disadvantages: Steeper learning curve; potential for incomplete release or nerve/vessel injury.

4. Ultrasound-Guided or Percutaneous Carpal Tunnel Release Description: Minimally invasive release under real-time ultrasound guidance, sometimes without any incisions (just needle or probe entry).

Advantages: Very fast recovery, minimal tissue trauma.

Disadvantages: Requires expertise in imaging; not widely available