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Endoscopic surgery uses a thin, flexible
tube with a camera attached (endoscope). The endoscope is guided through a
small incision in the wrist (single-portal technique) or at the wrist and palm
(two-portal technique). The endoscope lets the doctor see structures in the
wrist, such as the transverse carpal ligament, without opening the entire area
with a large incision.
The cutting tools used in endoscopic
surgery are very tiny. They, also, are inserted through the small incisions in the
wrist or wrist and palm. In the single-portal technique, one small tube
contains both the camera and a cutting tool.
During endoscopic carpal tunnel release surgery, the
transverse carpal ligament is cut. This releases
pressure on the
median nerve, relieving
carpal tunnel syndrome symptoms.
The small incisions in the palm are closed with stitches. The gap where
the ligament was cut will eventually fill with scar tissue.
have endoscopic carpal tunnel release surgery, you likely will not have to stay
in the hospital. You can go home on the same day.
You can expect a shorter recovery
period after an endoscopic surgery than after open surgery, because the
procedure does not require cutting the palm open and disturbing a large area of
The pain and numbness may go away right after surgery,
or it may take several months. Try to avoid heavy use of your hand for a couple
How soon you can return to work depends on whether your
dominant hand (the hand used most, such as the right hand if you are
right-handed) was involved, on your work activities, and on the effort that you
put into rehabilitative physical therapy.
Endoscopic carpal tunnel release
surgery is considered when:
A person who is having surgery on both wrists, or who
depends on a wheelchair, a walker, or crutches, may choose endoscopic surgery
because the healing time can be shorter than with open surgery.
Most people who have surgery for
carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their
hand after surgery.1
In rare cases, the
symptoms of pain and numbness may return (the most common complication), or
there may be temporary loss of strength when pinching or gripping an
If the thumb muscles have been severely weakened or wasted
away, hand strength and function may be limited even after surgery.
The risk and complication rates for endoscopic
surgery are very low. Major problems such as nerve damage happen in fewer than
1 out of 100 surgeries (less than 1%).2
Possible problems from endoscopic carpal release surgery include injury
to nerves, blood vessels, and tendons. There are also the risks of any type of
surgery, including possible infection and
risks of general anesthesia. But most endoscopic
carpal tunnel surgery is done with
local anesthesia or regional block rather than with
If you are going to have an
endoscopic carpal tunnel release, look for a surgeon who has experience doing
endoscopic surgery. Ask how successful he or she has been with people who had
conditions similar to yours.
Both endoscopic and open carpal
tunnel release have benefits and risks. Studies do not show that one procedure
is better than the other.2 Talk to your doctor about
Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Ashworth N (2011). Carpal tunnel syndrome, search date July 2011. Online version of BMJ Clinical Evidence (10).
Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
October 2, 2012
Kathleen Romito, MD - Family Medicine & Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
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