[Operative treatment for carpal tunnel syndrome]

Carpal tunnel syndrome is an entrapment neuropathy where the median nerve is compressed inside of the carpal canal. Causes of this syndrome include repetitive strain, wrist fracture, rheumatoid arthritis, space-occupying lesion, dialysis-related amyloidosis, diabetes mellitus, and in addition, cases with no apparent cause. Similar symptoms such as numbness, sensory disturbance of the median nerve distribution area and weakness of thenar muscles also occur in patients who suffer from cervical diseases. In cases where the patient suffers from both carpal tunnel syndrome and cervical disease, the patient's complaints may not disappear if treatment is only performed for one of them. Therefore, accurate diagnosis of the cause of the symptoms, using electrophysiological test results and/or carpal canal pressure measurement results is essential to the successful treatment of such patients. The purpose of operative treatments for carpal tunnel syndrome is to decompress the median nerve. A variety of operative treatment techniques, i.e., standard open procedure, minimum incision open procedure, one-portal or two-portal endoscopic procedures, etc., are used. Every procedure has different conditions such as equipment used, operative hand positions, location and size of skin incisions, blind ways or no blind ways, approaches to target tissues, tourniquet usage and others. I developed the world's first endoscopic operative procedure for carpal tunnel syndrome using the Universal Subcutaneous Endoscope (USE) system in 1986 and I have operated on over 7,300 hands during these last 20 years. My technique has been proven by pre- and postoperative carpal canal pressure and intraneural median nerve pressure measurement results as an evidence-based medicine. Before an operative method is chosen, the most important thing to consider is whether or not it will safely and completely achieve the purpose as evidence-based medicine with minimal invasion of the patient.