Endoscopic carpal tunnel surgery for carpal tunnel syndrome

Surgery Overview

Endoscopic surgery uses a thin, flexible 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 and are also 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.

See an illustration of endoscopic carpal tunnel release surgery.

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 usually do 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.

How soon you can return to work depends on whether your dominant hand (the hand used most, such as the right hand if you are right-handed) was involved, on your work activities, and on the effort that you put into rehabilitative physical therapy.

• If you have surgery on your nondominant hand and don't do repetitive, high-risk activities at work, you may be able to return to work within 1 to 2 days.
• If you have surgery on your dominant hand and do repetitive activities at work, you may require 4 or more weeks for recovery. Physical therapy may speed recovery.

Why It Is Done

Endoscopic carpal tunnel release surgery is considered when:

• Symptoms are still present after a long period of nonsurgical treatment. Generally, surgery is not considered until after 3 to 12 months of non-surgical 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 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.

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. The overall success rate for endoscopic and open surgery is more than 95%.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, due to the cutting of the transverse carpal ligament.

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, with reports ranging from about 5% to no complications among nearly 100 single-portal surgeries.^{1, 2}

Possible complications of 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. However, most endoscopic carpal tunnel surgery is done with local anesthesia or regional block, rather than 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.

Should I have surgery for carpal tunnel syndrome?

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.