SRECTR for Carpal Tunnel Syndrome Protects Tendons, Reduces Risk of Postoperative Nerve Damage

21 June 2024

Carpal tunnel syndrome is a condition in which swelling of the tendons, combined with sclerosis of the transverse carpal ligament, compresses the median nerve, causing pain, tingling and numbness in the thumb, index, middle and ring fingers. After non-surgical treatment fails, surgical treatment may be considered. Endoscopic Carpal Tunnel Release combined with the new superior chamber endoscopic release technique can significantly minimize the risk of injury to other nerves and tendons, improve pain symptoms and restore hand function quickly after surgery.

According to Sunway Medical Centre, Sunway City Consultant Hand & Microsurgery, Dr Teh Kok Kheng, Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy of the upper extremity.

He explained, there are nine tendons in the carpal tunnel that control the movement of the fingers and correspond to each finger, which is one tendon for the thumb and two tendons for each of the other fingers, and the median nerve, which passes through the carpal tunnel, controls the thumb, index finger, middle finger and half of the ring finger.

“The surrounding tendons become swollen due to various reasons (e.g. gout, rheumatoid arthritis, etc.), resulting in the narrowing of the wrist tunnel; coupled with the aging of the body, the hardening of flexor retinaculum or the transverse carpal ligament resulting in compression of the median nerve that passes through the narrowed wrist tunnel, causing pain, tingling and numbness in the thumb, index finger, middle finger and ring finger.

“The compression of the median nerve through the narrow wrist tunnel causes pain, tingling, and numbness in the thumb, index finger, middle finger, and ring finger; some of the median and ulnar nerves are located in the forearm, and sometimes the patient is unable to differentiate between numbness and pain,” he says.

There are many risk factors for CTS, which include age over 50, pre-menopause and menopause, pregnancy, breastfeeding; chronic illnesses such as gout, diabetes, high blood pressure and chronic kidney disease; other than that, repetitive movements of the wrists, such as factory workers on assembly lines, manual laborers and office workers also part of the risk factors.

He shared, generally, about 5% of the population suffers from CTS, and the majority of CTS patients are women, especially pre-menopausal or menopausal women.

He reveals that most of his patients are menopausal women over 50 years of age and in an earlier study I conducted, the male to female ratio was 1:9.

“The high percentage of female patients is due to the absence of estrogen secretion after menopause, which leads to edema in the body and swelling of the carpal tunnel, and the development of the aforementioned disease.

“Secondly, pregnant women are prone to edema during pregnancy, resulting in swelling of the carpal tunnel and this group of patients can receive non-pharmacological treatments to improve their symptoms, and most of them will be fine after giving birth, however, there is a risk of recurrence after they reach their 50s or 60s. Many of the laborers and factory workers mentioned earlier are also men, and this group may also suffer from CTS,” he added.

In terms of treatment, he says, it can be mainly categorized into non-operative treatment and operative treatment.

“The principle of non-operative treatment is to reduce swelling and abrasion of the median nerve in the carpal tunnel canal whereas surgical treatments are categorized as Open Carpal Tunnel Release (OCTR) and Endoscopic Carpal Tunnel Release (ECTR).

“To minimize the risk, I developed a new technology called Supraretinacular Endoscopic Carpal Tunnel Release (SRECTR) and SRECTR has the advantage of reducing damage to the internal structures of the carpal tunnel, especially the median nerve and tendons for which there is a lower risk of complications; at the same time, postoperative wounds and scars are smaller and recovery is faster,” he explained.

He advice to people who are engaged in laborious work or work that requires repetitive use of their hands, such as factory workers in factories must pay more attention.

“I recommend taking a short break after a period of work to relax the hands that are frequently operated.

“For office workers who use computers for a long time, I suggest getting up every hour and stretching the limbs to reduce the position of shoulders, elbows, wrists and hands to maintain the same posture for a long time; at the same time, they can also adjust the computer, keyboard and mouse to the right position to minimize neck and shoulder pain and to avoid suffering from CTS,” he emphasize.

Source: Sin Chew Daily 

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