Open Versus Endoscopic Carpal Tunnel Surgery – the Basics

Each year over 350,000 people in America undergo a carpal tunnel release. Carpal tunnel syndrome entails one of the most significant work absence causes every year in the US.

The open carpal tunnel surgery is done to relieve median nerve pressure, reducing the pain from the syndrome. Typically patients regain normal sensation to the fingers and hands.

The surgery is commonly performed on an outpatient basis. The surgeon creates a tiny incision between 1 and 2 inches in the palm of the hand to expose the transverse carpal ligament, which overlies the carpal tunnel.

Between the overlying transverse carpal ligament and the median nerve, a metal guide is placed. More space is created as the surgeon cuts above the metal guide through the ligament. This gives the median nerve more room to “breathe” and eventually regenerate with less pain and increased motor function and better sensation.

Once the ligament is cut, the incision is closed with sutures, a splint is applied to the wrist, and the patient is usually allowed to go home as soon as the anesthetic wears off. Within a couple weeks, patients often begin hand therapy to regain lost strength and for effective pain control post-operatively.

The endoscopic carpal tunnel release is also done as an outpatient. It is designed to end up with less pain and scarring than open release and attempts to make for a quicker recovery.

The endoscopic surgery incision is smaller than the open one and similarly a metal guide is inserted over the median nerve. A video camera is inserted which sends images to an OR television. The surgeon can see the inside of the hand and wrist.

Using the monitor, the surgeon transects the transverse ligament, reducing the median nerve pressure. The camera is removed, and the wound is sutured. A wrist splint may be put on and hand therapy may be started within a week or so to help with wrist and hand strength.

Numerous studies have been done looking at outcomes of patients undergoing endoscopic carpal tunnel release versus open release. The endoscopic variety appears to provide a faster recovery to operated patients in the short term with faster relief of pain and faster improvement in functional abilities. Long term the results appear to be equivalent.

Both endoscopic and open surgeries are equally effective in relieving carpal tunnel symptoms. The increased cost of endoscopic surgery is substantial, and it’s unclear if the benefits are worth that extra cost.

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