Locally Made Instruments for Endoscopic Carpal Tunnel Release

Abstract

Endoscopic carpal tunnel release (ECTR) was introduced into Thailand when this technique became widely accepted. However, the technique was limited to only a few institutions because of the training required and the very high cost of the instruments. Because of the economic crisis in Thailand, most hospitals in the public health ministry had no budget to invest in new instruments. However, new technology cannot be ignored so the authors modified some unused instruments in conjunction with an arthroscope in order to perform ECTR. A 5 cm by 4 mm slot was made at the mid-portion of an old unused 5 mm arthroscopic sheath. One end of this sheath was reshaped to fit the meniscectomy hook blade. A 4.5 mm Steinmann pin was reshaped to be the obturator of the arthroscopic sheath. ECTR was performed with this instrument in conjunction with an arthroscope (modified from Chow's 2-portals technique). The transverse carpal ligament was clearly viewed and identified, and the transverse carpal ligament was completely divided by the menisectomy hook blade. The operation time was 10 to 20 minutes. 30 patients received ECTR with this set of instruments, and they were completely relieved from the symptoms and returned to work early without any complications. The advantages of this instrument are that it is very cheap, it has a low learning curve, and it is safe and effective.