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 After Surgery
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.
- Carpal Tunnel Syndrome: Should I Have Surgery?
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html. Accessed October 2, 2014.
- Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
Credits
ByHealthwise Staff
Primary Medical ReviewerKathleen Romito, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerHerbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
Current as ofMarch 21, 2017