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Endoscopic Carpal Tunnel Surgery for Carpal Tunnel Syndrome

Surgery Overview

Endoscopic surgery uses a thin tube with a camera attached (endoscope). The endoscope is guided through a small incision in the wrist (single-portal technique) or at the wrist and palm (two-portal technique). The endoscope lets the doctor see structures in the wrist, such as the transverse carpal ligament, without opening the entire area with a large incision.

The cutting tools used in endoscopic surgery are very tiny. They, also, are inserted through the small incisions in the wrist or wrist and palm. In the single-portal technique, one small tube contains both the camera and a cutting tool.

During endoscopic carpal tunnel release surgery, the transverse carpal ligament is cut. This releases pressure on the median nerve, relieving carpal tunnel syndrome symptoms.

The small incisions in the palm are closed with stitches. The gap where the ligament was cut will eventually fill with scar tissue.

If you have endoscopic carpal tunnel release surgery, you likely will not have to stay in the hospital. You can go home on the same day.

What To Expect

You can expect a shorter recovery period after an endoscopic surgery than after open surgery, because the procedure does not require cutting the palm open and disturbing a large area of the hand.

The pain and numbness may go away right after surgery, or it may take several months. Try to avoid heavy use of your hand for a couple of weeks.

The timing of your return to work depends on the type of surgery you had, whether the surgery was on your dominant hand (the hand you use most), and your work activities.

If you had open surgery on your dominant hand and you do repeated actions at work, you may be able to return to work in 6 to 8 weeks. Repeated motions include typing or assembly-line work. If the surgery was on the other hand and you do not do repeated actions at work, you may be able to return to work in 7 to 14 days.

If you had endoscopic surgery, you may be able to return to work sooner than with open surgery.

Why It Is Done

Endoscopic carpal tunnel release surgery is considered when:

  • You still have symptoms after a long period of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
  • Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict your normal daily activities.
  • There is damage to the median nerve (shown by nerve test results and loss of hand or finger function) or a risk of damage to the nerve.

A person who is having surgery on both wrists, or who depends on a wheelchair, a walker, or crutches, may choose endoscopic surgery because the healing time can be shorter than with open surgery.

How Well It Works

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery.footnote 1

In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object.

If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

Risks

The risk and complication rates for endoscopic surgery are very low. Major problems such as nerve damage happen in fewer than 1 out of 100 surgeries (less than 1%).footnote 2

Possible problems from endoscopic carpal release surgery include injury to nerves, blood vessels, and tendons. There are also the risks of any type of surgery, including possible infection and risks of general anesthesia. But most endoscopic carpal tunnel surgery is done with local anesthesia or regional block rather than with general anesthesia.

What To Think About

If you are going to have an endoscopic carpal tunnel release, look for a surgeon who has experience doing endoscopic surgery. Ask how successful he or she has been with people who had conditions similar to yours.

Both endoscopic and open carpal tunnel release have benefits and risks. Studies do not show that one procedure is better than the other.footnote 2 Talk to your doctor about your options.

References

Citations

  1. Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html. Accessed October 2, 2014.
  2. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).

Credits

Current as ofSeptember 20, 2018

Author: Healthwise Staff
Medical Review: Kathleen Romito, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Herbert von Schroeder, MD, MSc, FRCS(C) - Orthopedics, Hand and Microvascular Surgery


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