Houston Methodist. Leading Medicine

Hand FAQ

Question:

I had that new fancy carpal tunnel release without a scar. I thought it was going to give me a speedy recovery. But I noticed a fellow co-worker who had the same surgery with an open incision was back to work just as fast. What's the advantage of this new technique? Is there one or did I just get talked into something I really didn't need?

Answer:

Carpal tunnel syndrome (CTS) is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment or compressive neuropathy. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS. The carpal tunnel is an opening through the wrist to the hand that is formed by the bones of the wrist on one side and the transverse carpal ligament on the other. (Ligaments connect bones together.) This opening forms the carpal tunnel. The median nerve passes through the carpal tunnel into the hand. It gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips of each finger on the same hand, a motion called opposition. Patients can be treated surgically for carpal tunnel syndrome with two different surgical approaches. One is the more traditional open carpal tunnel release. The second is an endoscopic release, which is an accepted, but not widely used, surgical procedure. In both operations, the transverse carpal ligament across the carpal tunnel is cut and released. In the open surgery, an incision is made down the palmar side of the wrist and the carpal tunnel ligament is released. In the endoscopic procedure, a small opening is made in the skin and a special surgical device called the endoscope is slipped under the skin into the carpal tunnel area. The scope has a tiny TV camera on the end that allows the surgeon to see as the release is performed. There are numerous studies published now that compare endoscopic with open release surgery. A recent landmark study from Sweden offers some interesting insight into the differences between these two approaches. Except for less pain postoperatively (first three months) for endoscopic patients, results are the same for these two types of surgery. Patients reported the same (good to excellent) results in pain reduction. Time between surgery and return-to-work was the same. Function and need for repeat surgery due to persistent pain were also the same between the two groups. All of this mimics what you saw in the office setting in which you work. Endoscopic surgery for carpal tunnel release may be less invasive and thus has a small benefit when it comes to postoperative pain. But in regards to complication rate, return-to-work status, or function, the endoscopic approach was not superior to the open technique. Isam Atroshi, MD, PhD, et al. Open Compared with 2-Portal Endoscopic Carpal Tunnel Release: A 5-Year Follow-Up of a Randomized Controlled Trial. In The Journal of Hand Surgery. February 2009. Vol. 34-A. No. 2. Pp. 266-272.

*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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