Houston Methodist. Leading Medicine

Hand FAQ

Question:

I'm a little bit bummed that the carpal tunnel release surgery I had done a few years ago can be done now without a visible scar. Do they get as good of results that way as with the kind I had with a full incision?

Answer:

It's true that open incision carpal tunnel release is being replaced by the endoscopic (minimally invasive) approach. But open incision surgery is still in use and the jury is still out, so-to-speak, on the comparative results. Now for the first time, results of a long-term study on open incision carpal tunnel release have been published from Harvard Medical School in Boston, Massachusetts. One (fellowship-trained) hand surgeon who had performed 211 open carpal tunnel releases contacted his patients 11 to 17 years after the procedure. Using a series of self-assessment surveys, symptoms, function, and patient satisfaction were measured. Of course, in that amount of time, some patients had died and others could not be located. There were also 27 patients who did not want to be part of the study. But they found 113 people who participated in the study. The patients included adults of all ages from under fifty years of age to sixty and older. There were adults who were actively employed and working, retirees, and pre-and postmenopausal women. They discovered that three-fourths of the group no longer had any carpal tunnel problems. Most of the problematic symptoms went away in the first year after the surgery. Almost 90 per cent (88 per cent to be exact) were very satisfied or completely satisfied with the results. For the people who still had some symptoms of carpal tunnel syndrome, the most common symptom was hand weakness (e.g., grip and pinch strength, difficulty opening jars or holding a book). Daytime pain, numbness, and tingling were also reported by a few people. Patients who had the most difficulty years later were those who also had diabetes, rheumatoid arthritis, osteoarthritis, or polyneuropathy. All of these conditions are linked with carpal tunnel syndrome. It is likely that the problems encountered with functional tasks was really related more to these comorbidities (other conditions) than the after-effects of carpal tunnel surgery. Only two of the 113 patients had to have a second (repeat) surgery. And only a few patients had pain at night or tenderness along the (healed) incision line. Analysis of all the data did not show any particular pain patterns associated with age. But function was worse in the middle age group (ages 50 to 59). The reason(s) for the connection between middle ages and worse function were unknown. It's possible that the older age group had worse function but accept their limitations and/or have fewer physical demands placed on them so the loss of function is not as noticeable. This is one of the few long-term studies of results following open carpal tunnel release. As mentioned, more carpal tunnel surgeries are done endoscopically now with minimally invasive techniques. So it is possible that this will be one-of-a-kind study. But the results clearly show that excellent early improvements are maintained over the long-term with equally excellent reports of patient satisfaction and improved quality of life. Those patients (like yourself) who had the more invasive (open) incision approach may have a visible scar but the long-term results are excellent, possibly making that thin line worth it anyway. Dexter L. Louie, BA, et al. Outcomes of Open Carpal Tunnel Release at a Minimum of Ten Years. In The Journal of Bone and Joint Surgery. June 19, 2013. Vol. 95A. No. 12. Pp. 1067-1073.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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