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HomeSummaryReview of the conditionConsidering surgeryTypes of surgery recommended Who should consider endoscopic carpal tunnel syndrome?What happens without surgery?Surgical options Effectiveness Urgency Risks Managing risk Preparing for surgeryAbout the procedureRecovering from surgeryRehabilitationConclusion

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Carpal Tunnel Syndrome: Minimally Invasive Endoscopic Carpal Tunnel Release

Edited By: Thomas Trumble, M.D.
Last updated Wednesday, December 30, 2009

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Considering surgery

Types of surgery recommended

Carpal tunnel release is a very reliable surgery. It can be done as an open technique with an incision in the palm or as an endoscopic technique that uses special technology with fiber optic cables and a camera to help the surgeon see the ligament that needs to be released without making a larger incision in the palm. There is one endoscopic technique that requires 2 incisions and one that only requires a single incision. The single incision technique is the only method that avoids an incision in the palm.

Who should consider endoscopic carpal tunnel syndrome?

Endoscopic Carpal Tunnel Release is considered when:

The patient has recurrent problems with numbness that interferes with activities or sleep.
The EMG/NCV is positive.
The patient understands the risks and alternatives
The surgeon is experience in endo-CTR.
Endo-CTR is helpful when carpal tunnel syndrome is confirmed in patients of all ages and all walks of life. It can be performed as an outpatient surgery with minimal risk to the patient.

What happens without surgery?

The numbness with carpal tunnel does not tend to improve, and it generally progresses slowly overtime. The rate of change in symptoms can vary. Some patients may develop permanent weakness if the pressure on the nerve is not relieved.

Surgical options

Most surgeries for CTS release the ligament to take the pressure off of the nerve. Ligament release techniques can be open or endoscopic with a smaller incision. Less common techniques involve stripping the lining off the tendons (synovectomy) or expanding the ligament. Without a release of the ligament, there is the problem of the pressure returning.

Effectiveness

In the hands of an experience surgeon, the technique can provide permanent relief. It is rare to have to revise the surgery.

Urgency

Surgery for CTS is not an emergency. The surgery should be scheduled when the symptoms cause a significant irritation to the patient. Although surgeries can be performed on both hands at the same time if both are significantly affected, most patients prefer to stagger the surgeries at least one month or more apart.

Risks

The risks of endoscopic carpal tunnel release include but are not limited to nerve injury infection, recurrence of the symptoms, tendon injury and scar tenderness. An experienced hand team will use specialized techniques to minimize these risks but cannot totally eliminate them.

Managing risk

Infections are extremely rare in carpal tunnel surgery but antibiotics can treat them. Nerve or tendon injury can be treated by surgical repair. Recurrence of symptoms can be treated by revision surgery. In one study of 10,000 consecutive cases of single incision endoscopic carpal tunnel surgery, there were no long-term complications that required revision surgery.²

Surgery for carpal tunnel syndrome at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA

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