Here I am showing the landmarks that we use for the operation, although typically we do not draw them on every patient.

The local anaesthetic is uncomfortable but not too painful. We put it in two areas: around the wrist crease and then more deeply in the wrist around the tendons.

We also need some in the palm to anaesthetise where we are going to cut. We often use a mixture of local anaesthetics and sometimes add an agent to help the local spread more widely so we can as here do it all with one injection.

This is the typical incision I use for the endoscopic CTR. The wound is made above the wrist and in one of the natural creases allowing the wound to settle quickly.

At the end of the operation we use dissolving sutures and paper tapes to seal the wound.

Here we see the device inserted in the wound and below the picture we see on the TV screen attached to the camera. By pulling on the trigger we can move the knif up and down and release the ligament from inside.

TV camera

Device

Cut edges of the ligament

Clicking on the picture above should launch a video of the operation in real player format. If this does not happen please either download realplayer from www.realplayer.com or play a windows media format here

The wrist after the operation before the padded bandage is applied.

The padded bandage is left in place for 48 hours and then removed by the patient..

There are no restrictions on your activities after the first 48 hours although some patients will have discomfort on use.

The advantage of this technique is early return to activities, typically several weeks earlier. The overall success rate of the two techniques is identical. However the reduced pain and earlier use are preferred by most patients.