Are you suffering from carpal tunnel syndrome? You are not alone! It is a frequent disease, affecting one person in ten. Carpal tunnel syndrome is frequent in women between 40-60 years of age but may also be seen in men and younger or older age groups. Diabetic patients are particularly affected. Carpal tunnel syndrome occurs during pregnancy and usually disappears spontaneously after delivery.

The carpal tunnel is a narrow osteo-fibrous passageway in the wrist containing nine flexor tendons and the median nerve. Under overuse conditions (repetitive hand activities), the tissue surrounding the flexor tendons thickens, causing a mechanical compression on the median nerve, resulting in pain, numbness, and tingling in the hand and arm, particularly at night – this is the carpal tunnel syndrome. The disease is frequently bilateral (affecting both hands). Sometimes there is another cause of nerve compression, like a deep ganglion or a bony problem.

Carpal tunnel syndrome is quite painful, prevents sleep at night, and tends to aggravate over time, causing long-term irreversible sensory and motor nerve damage, so early diagnosis and treatment are essential. The diagnosis is usually done by nerve conduction studies and electromyography, sometimes by sonography, or both.

In early cases, non-operative treatment is advised, particularly wearing a night splint, keeping the wrist in a neutral position, and/or performing a corticosteroid infiltration of the carpal tunnel. Nerve gliding exercises may also help. Most carpal tunnel syndromes need, over time, surgical decompression to give more room to the nerve. The classical operation is open surgery with a section of the transverse carpal ligament, enlarging the tunnel. The incision is 4-5cm long. After the procedure, the night pain usually quickly disappears, but the surgical wound healing takes time, preventing an early return to daily activities and work. Many patients also complain of a transient decrease of their grip strength and pain at the base of the wrist, called “pilar pain”, lasting months or sometimes years. Other complications are sometimes seen, some quite severe (i.e., infection, inadvertent lesion to a branch of the median nerve, CRPS, which is a syndrome of chronic severe pain in the whole hand). To reduce the rate of unsatisfactory results and allow a quicker return to work, surgeons have developed methods to limit the size of the surgical skin incision (“minimally invasive techniques”), providing the same opening of the tunnel, either by a smaller incision (“mini-open” technique), by using an endoscope (one or two small skin incisions are needed to introduce the instruments), or by percutaneous technique (without any skin incision), under sonography. Spirecut develops the ideal surgical tool, which we call the Sono-Instrument®, to achieve the latter method for the great benefit of the patients. Note that the rate of pillar pain is approximately the same, whatever open or minimally invasive technique is used. Still, endoscopic and particularly percutaneous procedures allow quicker return to work and better preserve the patient’s grip strength. With the percutaneous technique, the patient may use and wash his/her hand the day after the operation.