by Raymond K. Wurapa, M.D.

Endoscopic Carpal Tunnel Surgery

Endoscopic carpal tunnel surgery uses a thin, specialized device with a camera attached (endoscope), guided through a small incision at the wrist (single-portal technique). The device contains both the camera and the cutting tool. The endoscope lets the surgeon directly and clearly see the internal structures of the wrist, such as the transverse carpal ligament, without opening the entire area with the standard, larger incision.

During endoscopic carpal tunnel release surgery, the transverse carpal ligament is cut, releasing pressure on the median nerve, relieving the symptoms of carpal tunnel syndrome. The small incision in the palm is closed with stitches. The gap where the ligament was cut is expected to eventually fill with scar tissue, but maintaining the now increased space of the carpal tunnel. This is an outpatient surgery allowing you to go home on the same day.

You can expect a shorter recovery period after an endoscopic carpal tunnel release than after open surgery, because the procedure does not require a large incision in the palm, which disturbs a larger area of the hand. A person 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.

The pain and numbness may go away right after surgery, but typically take several months for maximal recovery. The incision and dressing are kept dry for the first 4-5 days followed by routine hand washing/ bathing practices. Heavy use of your hand is restricted for the first 2 weeks.

How soon you return to work depends on whether surgery involved your dominant or non-dominant hand, and on your specific work demands. Rehabilitative occupational therapy is available but typically is not required.

In cases of severe carpal tunnel syndrome where hand muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

Both endoscopic and open carpal tunnel release have benefits and risks. The risks and complication rates are typically very low. Despite the faster early rehabilitation attributed to endoscopic surgery, studies do not show that one procedure is better than the other in terms of long term nerve recovery. Not every patient is an ideal candidate for endoscopic surgery.