FAQs on Endoscopic Carpal Tunnel Release
Many of 350,000 patients undergoing surgeries to treat carpal tunnel syndrome every year in the United States prefer endoscopic carpal tunnel release. Used since 1990s and most common among hand surgeries, the procedure is more convenient and less invasive with faster recovery and reduced postoperative discomfort. The success rate is over 90%.
What is endoscopic carpal tunnel release?
Endoscopic carpal tunnel release is a surgical procedure to decompress the carpel tunnel, relieve the compressed median nerve, and treat painful symptoms associated with its compression. The process involves insertion of an endoscope, a tube-like long, slender instrument connected with a video monitor, through a small incision just below the wrist to visualize structures in the tunnel. Images generated by it enable surgeons to decompress the tunnel by cutting down the ligament squeezing on the median nerve or tendons in the tunnel.
What is carpal tunnel syndrome?
The carpal tunnel is a passageway located at the entrance of the wrist on the palm side. The medial nerve and flexor tendons providing functional sensation to fingers passes through it. However, the tunnel is too narrow due to presence of bones on two sides and a thick ligament making the roof. Any inflammation or swelling in tendons results in nerve impingement and pain.
Carpal tunnel syndrome leads to sharp pain, weakness, decreased motor skills, and aching in the palm and fingers. Patients find it difficult to grasp things or perform daily tasks.
Endoscopic carpal tunnel release refers to cutting the transverse carpal ligament from inside out so that the tunnel broadens and pressure on the median nerve is relieved.
Who is a candidate for endoscopic carpal tunnel release?
One is suggested to have the endoscopic carpal tunnel release when
- nonsurgical interventions proves futile
- electromyography test indicates severe carpal tunnel syndrome
- painful symptoms continue for more than six months
- changes in the shape and size of hand and wrist muscles
- chronic medial nerve impingement
Is an endoscopic carpal tunnel release better than open surgery?
Endoscopic carpal tunnel release is less invasive, and there is no scarring of the palm. Patients prefer it for less pain and faster recovery. The procedure also has extremely low chance of surgical complications. Palm is not injured and you can return to your job within days.
How is endoscopic carpal tunnel release performed?
Patients are administered local anesthesia to numb the wrist. Occasionally, doctors go for general anesthesia.
An incision is made just below the wrist on the forearm side. Some surgeons make a second incision on the palm side. A cannula is put through the incision and an endoscope is inserted in to the carpal tunnel to visualize the underside of the carpal ligament. The live images guide the carpal tunnel release procedure.
A knife-like instrument is also inserted to dissect the carpal ligament from inside without violating the skin of the palm. This loosens roof pressure on the tunnel and relieves the medial nerve from being squeezed. The skin incision is stitched.
How long it takes to perform endoscopic carpal tunnel release?
It takes about 30 minutes to 1 hour to perform an endoscopic carpal tunnel release.
Do I need to stay at the hospital after endoscopic carpal tunnel release procedure?
The release surgery is performed in an outpatient clinical setting and there is no need to stay in the hospital. Patients are discharged within an hour of the surgery.
Do I need rest after endoscopic carpal tunnel release surgery?
Rest for a day or two is recommended. However, your hand remains bandaged for a week. You can use your hand without any restriction after a week.
What kind of rehabilitation is needed following endoscopic carpal tunnel release surgery?
Start with finger motions on the day after surgery. But avoid grasping or pinching activities to prevent tendons rubbing with dissected carpal ligament. Start active hand movements and soft-tissue massage after four weeks in consultation with a physical or occupational therapist. Use fist positions to ensure sliding of flexor tendons inside the tunnel. Range-of-motion, dexterity, and motor control exercises are important elements of rehabilitation process after the sixth week.
You can perform light activities after a week and recover completely in 6 to 8 weeks.
What are the restrictions following the hip implant surgery?
- No driving for at least three weeks
- Using a splint for a week to provide rest to your wrist from stress
- Avoid grasping or pinching activities for 6 weeks
- Keep the bandage clean and dry
What are the potential complications of endoscopic carpal tunnel release surgery?
Temporary pain and stiffness may be felt for days after the endoscopic carpal tunnel release surgery. Patients may suffer from infection, blood vessel injury, nerve injury, bleeding, and wrist weakness. These symptoms can be avoided by following the standard surgery protocol.
Atroshi I, et al. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomized controlled trial. BMJ Jun 2006; 332
Chow JC. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy (1989);2: 19–24
Agee JM, et al. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am 1992;17A: 987–95
Vasen AP, et al. Open versus endoscopic carpal tunnel release: a decision analysis. J Hand Surg Am 1999;24A: 1109–17
Trumble, Thomas E, et al. Gilbert-Anderson, Mary M. (2002). “Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial”. The Journal of bone and joint surgery 84–A (7): 1107–15
Beck J D, et al. “Results of Endoscopic Carpal Tunnel Release Relative to Surgeon Experience With the Agee Technique.” Journal of Hand Surgery 36:1, pp 61-64, Jan 2011