Percutaneous carpal tunnel plasty method

Abstract

Nerve entrapment such as Carpal Tunnel Syndrome is relieved by a surgical procedure for increasing the spatial diameter of the tunnel enclosing the nerve, which involves inserting a protected balloon catheter into the tunnel and serially inflating and deflating the catheter while moving it along the tunnel from one end to the other.

What is claimed: 
     
       1. A surgical procedure for relieving nerve entrapment syndrome by increasing the spatial diameter of the carpal tunnel enclosing the nerve comprising making an incision through the skin subcutaneous tissue proximate the .entrapped nerve, retracting the incision, inserting a director means for protecting the nerve and underlying structure into said incision, inserting a deflated balloon catheter by means of said director means through said incision into said tunnel along with means for monitoring pressure in said tunnel, serially inflating and deflating said balloon catheter while intermittently moving it along the tunnel and continuously monitoring the pressure therein to thereby increase the diameter of the tunnel, deflating and removing said catheter, and director means from said incision and closing the incision. 
     
     
       2. The procedure of claim 1 wherein said procedure is continuously monitored optically. 
     
     
       3. The procedure of claim 1 wherein said balloon catheter is inflated by means of a liquid injected into it. 
     
     
       4. The procedure of claim 1 wherein said means for monitoring pressure is a pressure gauge. 
     
     
       5. The procedure of claim 1 wherein the transverse carpal ligament is expanded and dilated to increase the diameter of a carpal tunnel. 
     
     
       6. The procedure of claim 1 wherein said nerve is the median nerve. 
     
     
       7. A surgical procedure for decompressing the median nerve in the carpal tunnel by increasing the spatial diameter of the carpal tunnel enclosing the median nerve which comprises making an incision through the skin and subcutaneous tissue proximate the median nerve, retracting the incision, identifying the proximal portion of the transverse carpal ligament, inserting a grooved director means for protecting the nerve and carpal ligament into said incision, inserting a deflated balloon catheter by means of said director means through said incision along with pressure monitoring means underneath the transverse carpal ligament to the most distal end thereof; injecting a fluid into said balloon catheter and serially inflating and deflating said catheter while intermittantly moving it along said carpal tunnel from distal to proximal end and continuously monitoring the pressure therein thereby stretching the transverse carpal ligament, deflating and removing said catheter, director means and pressure monitoring means from said incision and closing the incision. 
     
     
       8. The surgical procedure of claim 7 wherein said procedure is monitored optically. 
     
     
       9. The surgical procedure of claim 8 wherein said optical monitoring is by means or image intensification or radiography. .Iadd. 
     
     
       10.  A surgical procedure for relieving nerve entrapment syndrome by increasing the spatial diameter of the carpal tunnel enclosing the median nerve, comprising the steps of: making an incision through the skin; inserting a surgical instrument into the incision, the instrument including an expandable member;   advancing the instrument within the incision such that the expandable member is positioned adjacent the transverse carpal ligament;   expanding the expandable member of the instrument such that the expandable member engages and stretches the transverse carpal ligament while avoiding contact of the expandable member with the median nerve to relieve pressure on the median nerve; and   removing the instrument from the incision leaving the transverse carpal ligament in a stretched condition. .Iaddend..Iadd.11. The surgical procedure of claim 10, further including the step of inserting a director member into the incision and positioning the director member so as to protect the underlying median nerve. .Iaddend..Iadd.12. The surgical procedure of claim 11, wherein the step of inserting the director member is performed prior to the step of inserting the surgical instrument. .Iaddend..Iadd.13. The surgical procedure of claim 12, wherein the step of inserting a surgical instrument includes guiding the instrument through the director member and into the carpal tunnel. .Iaddend..Iadd.14. The surgical procedure of claim 13, wherein the step of expanding the expandable member includes serially inflating and deflating the expandable member to stretch the transverse carpal ligament. .Iaddend..Iadd.15. The surgical procedure of claim 10, further including the step of monitoring the pressure in the carpal tunnel during the step of inflating the expandable member. .Iaddend..Iadd.16. A surgical procedure for treatment of carpal tunnel syndrome by relieving pressure on the median nerve by the transverse carpal ligament, comprising the steps of:   making an incision through the skin;   inserting through the incision an instrument having an expandable balloon and placing the instrument such that the balloon is positioned adjacent the transverse carpal ligament;   treating the symptoms of carpal tunnel syndrome by injecting a fluid into the balloon to expand the balloon against the transverse carpal ligament to stretch the transverse carpal ligment to a stretched condition thereby relieving pressure on the median nerve; and   removing the instrument from the incision leaving the transverse carpal ligment in the stretched condition. .Iaddend..Iadd.17. The surgical procedure of claim 16, further comprising the step of monitoring the pressure during the surgical procedure. .Iaddend..Iadd.18. The surgical procedure of claim 16, further comprising the step of inserting a director device in the incision to guide the instrument and to protect the median nerve. .Iaddend..Iadd.19. The surgical procedure of claim 16, wherein the step of injecting a fluid includes the step of providing a syringe containing saline to communicate with the balloon. .Iaddend..Iadd.20. The surgical procedure of claim 16, further comprising the step of viewing the position of the balloon by image intensification or radiography. .Iaddend..Iadd.21. A surgical procedure for treatment of carpal tunnel syndrome caused by compression of the median nerve by the transverse carpal ligament, comprising the steps of:   surgically accessing the transverse carpal ligament; and   alleviating the symptoms of carpal tunnel syndrome by performing a treatment on the transverse carpal ligament consisting essentially of the step of stretching the transverse carpal ligament to relieve pressure on the median nerve. .Iaddend..Iadd.22. The surgical procedure of claim 21, wherein the step of stretching the carpal ligament increases the diameter of the carpal tunnel. .Iaddend..Iadd.23. The surgical procedure of claim 22, wherein the step of surgically accessing the carpal ligament comprises the step of making an incision at the base of the palm distal to the wrist crease. .Iaddend..Iadd.24. The surgical procedure of claim 23, wherein the step of stretching the carpal ligament comprises the step of inserting a blunt tipped instrument supporting an expandable member and expanding the expandable member. .Iaddend..Iadd.25. A surgical procedure for treating carpal tunnel syndrome by stretching the transverse carpal ligament to relieve pressure on the median nerve by the transverse carpal ligament, comprising the steps of:   making an incision through the skin;   inserting a balloon catheter through the incision and positioning the balloon of the balloon catheter adjacent the transverse carpal ligament;   inflating the balloon of the balloon catheter to dilate at least a portion of the carpal ligament to increase the spatial diameter of the carpal tunnel to relieve compression of the median nerve wherein the step of inflating is in and of itself sufficient to relieve pressure on the median nerve to treat carpal tunnel syndrome; and   removing the balloon catheter after dilation of the transverse carpal   
     
     
        ligament leaving the carpal tunnel dilated. .Iaddend..Iadd.26.  The surgical procedure of claim 25, further comprising the step of positioning the balloon catheter in a grooved director device to protect the underlying median nerve. .Iaddend..Iadd.27. The surgical procedure of claim 26, wherein the step of inflating the balloon includes inflating the balloon intermittently along the carpal tunnel. .Iaddend..Iadd.28. The surgical procedure of claim 25, wherein the step of inserting the balloon catheter comprises inserting the balloon catheter underneath the transverse carpal ligament and above the median nerve. .Iaddend..Iadd.29. The surgical procedure of claim 28, wherein the step of inflating the balloon includes dilating an undersurface portion of the carpal ligament. 
     
     
        .Iaddend..Iadd.30.  A surgical procedure for relieving nerve entrapment syndrome by increasing the spatial diameter of the carpal tunnel enclosing the median nerve, comprising the steps of: making an incision through the skin;   inserting a surgical instrument into the incision, the instrument including an inflatable member;   advancing the instrument within the incision such that the inflatable member is positioned adjacent the transverse carpal ligament;   serially inflating and deflating the inflatable member to stretch the transverse carpal ligament to relieve pressure on the median nerve; and   
     
     
       removing the instrument from the incision. .Iaddend..Iadd.31.  The surgical procedure of claim 30 further including the step of intermittently moving the surgical instrument along the carpal tunnel from a distal to a proximal location, the step of intermittently moving the surgical instrument being performed simultaneously with the step of serially inflating and deflating the inflatable member. .Iaddend..Iadd.32. A surgical procedure for treatment of carpal tunnel syndrome caused by compression of the median nerve by the transverse carpal ligament, comprising the steps of: surgically accessing the transverse carpal ligament; and   stretching the transverse carpal ligament to relieve pressure on the median nerve thereby alleviating the symptoms of carpal tunnel syndrome without performing any other treatment on the transverse carpal ligament for relieving pressure on the median nerve. .Iaddend.