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Endoscopic surgery for carpal tunnel syndrome
By Mayo Clinic staffEndoscopic carpal tunnel surgery uses special tools and a tiny video camera inserted through one or two small incisions in your palm or wrist. You may not be a good candidate for this procedure if:
- Your carpal tunnel or median nerve is anatomically abnormal
- You have rheumatoid arthritis or diabetes
- Your physical examination and imaging studies strongly suggest that a tumor is compressing your median nerve
- You've had wrist surgery before
How is it done?
General anesthesia isn't necessary for endoscopic carpal tunnel surgery, but you may be sedated during the procedure. Your doctor will inject a numbing agent into your palm. A tourniquet may be placed on your arm to reduce the amount of blood flow to your hand.
Your surgeon makes one or two small incisions called portals. Many surgeons consider it safer to make two incisions — one in the palm and one in the wrist. With two portals, it may be easier for your surgeon to be sure that the carpal ligament has been completely cut. Each incision is about 1/2 inch (1.3 centimeters) long.
Specialized surgical instruments and a miniature video camera (endoscope) are passed into your wrist via the portals. Your surgeon manipulates the tools by watching the surgery's progress on a video monitor. The entire procedure usually takes less than 10 minutes.
Recovery
Endoscopic carpal tunnel surgery is an out-patient procedure, so you should be able to go home later that same day. You may need prescription pain medication for a few days, but many people only need over-the-counter drugs such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol, others).
Your doctor may want you to wear a splint on the hand for the first two weeks after surgery, to protect your wrist while it heals. Some doctors don't require a splint after endoscopic carpal tunnel surgery. But most agree that you shouldn't lift anything heavier than 11 pounds (5 kilograms) for two months after surgery.
Finger and wrist exercises typically begin immediately after surgery, to help prevent the nerves, tendons and supporting tissue from getting stuck in one position. You may also be instructed to begin carefully using your hand for daily activities as soon as possible.
Results
Some studies indicate that endoscopic procedures have a slightly higher risk of surgical complications — such as damage to the median nerve or incomplete division of the carpal ligament — than do open-release procedures. Other studies, however, show no difference in these risks between the two types of operations.
Because there is less pain after endoscopic procedures, recovery is often faster than after open-release surgeries. Depending on the type of work you do, you may be able to go back to work on light duty just a few days or a few weeks after surgery.
Some people have experienced both varieties of carpal tunnel surgery, typically having one type of surgery on one hand and then the other variety of surgery some years later on the other hand. More than 85 percent prefer the endoscopic technique to the open-release procedure.
Surgery for carpal tunnel syndrome: Pros and cons Open-release surgery for carpal tunnel syndrome
