First Description of Carpal Tunnel Syndrome

The first article linking compression of the median nerve to the symptoms of carpal tunnel syndrome was published in 1913 by Marie and Foix to the French Neurological Society. In the article, the authors note that "transection of the ligament could stop the development of these [symptoms]." The primary goal of a carpal tunnel release is to transect the transverse carpal ligament to release pressure on the median nerve in the carpal tunnel, but it was not until a decade later that a surgery was described that cut the transverse carpal ligament in these cases of carpal tunnel syndrome.

The History of Carpal Tunnel Surgery

The first reported carpal tunnel release was reported by Dr. Herbert Galloway in 1924 (Amadio; Papatheodorou and Sotereanos). The incisions were relatively large using a 5 to 6-cm incision over the palm. Over time surgeons have attempted to decrease the size of this incision to decrease side effects and improve recovery (Rojo-Manaute et al.).

Evolution of Carpal Tunnel Surgery

Newer image guided techniques have now been published to decrease the size of the incision, minimize complications and allow for a faster recovery.

In 1997, Nakamichi and Tachibana published an endoscopic carpal tunnel release technique to release the carpal tunnel using smaller incisions in the forearm and a camera to guide the surgical release. Various techniques have since been published with varying approaches, including a single 1 to 1.5-cm incision above the wrist or two incisions in the palm and forearm are made (Rojo-Manaute et al.; Nakamichi and Tachibana; Hansen and Majeed; Rojo-Manaute et al.; Hebbard et al.; Chern et al.; Burnham et al.; Petrover et al; Guo et al.; Latzka et al.; Henning et al.; Henning et al.; Apard et al.).

Now newer ultrasound guided carpal tunnel release techniques have been described.

Advantages of Carpal Tunnel Surgery using Ultrasound Guidance

Carpal tunnel surgery using ultrasound guidance uses a forearm incision similar to the endoscopic approach to minimize the recovery from cutting into the palm, however, the ultrasound provides a larger field of view than the endoscopic camera-based approach. The ultrasound allows for both visualization of both the ligament and neurovascular structures (i.e. the nerves) in real time (Rojo-Manaute et al.; Ohuchi et al.; Ohno et al.).

The ultrasound guided approach has been shown to be safe without injury to the nerves and a faster recovery than the “mini-open” technique (Rojo-Manaute et al.; Nakamichi and Tachibana; Petrover et al; Guo et al.; Latzka et al.; Henning et al.; Henning et al.; Apard et al.). The published data shows that 95% of patients were satisfied with the surgical outcomes (Rojo-Manaute et al.; Nakamichi and Tachibana; Petrover et al; Guo et al.; Latzka et al.; Henning et al.; Henning et al.; Apard et al.)

The forearm incision used in the ultrasound guided approach allows the patient to avoid the palmar incision that can lead to a functional decline after the “mini-open” approach (Rojo-Manaute et al.; Mahmood et al.).

The Future of Carpal Tunnel Surgery

An estimated 500,000 carpal tunnel releases are performed annually in the United States (Pourmemari et al).Despite advances in carpal tunnel surgery, currently the majority of carpal tunnel surgery is performed using an open approach. Up to 70 to 80% of carpal tunnel surgeries are performed using a “mini open” approach with an incision size ranging from 2 to 4-cm, and(Papatheodorou and Sotereanos; Kang et al.).

Learn more about carpal tunnel surgery using ultrasound guidance (here).

References

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