What is Endoscopic Carpal Tunnel Surgery?

Endoscopic carpal tunnel surgery is a medical procedure used to treat persistent symptoms and avert nerve damage associated with carpal tunnel syndrome. Individuals whose symptoms have been unresponsive to traditional treatment, have nerve damage, or whose condition has adversely impacted daily activities and functioning may choose undergo endoscopic carpal tunnel surgery. As with any medical procedure, there are risks associated with endoscopic carpal tunnel surgery and these should be discussed with a qualified health care provider prior to pursuing this treatment option.

Carpal tunnel syndrome results from the compression of the median nerve, which runs through the carpal tunnel located on the inside of the wrist. Symptoms associated with carpal tunnel syndrome manifest gradually and may start with a dull aching sensation in the wrist. Individuals with this syndrome may experience symptoms that include numbness or tingling of the fingers, radiating pain that travels either up the arm or down into the fingers, or hand weakness that affects his or her ability to grip objects.

A diagnosis of carpal tunnel syndrome is generally confirmed through the administration of one or more tests. To determine whether any muscle damage has occurred, a doctor may perform an electromyogram, which measures the electrical discharge produced by the muscles upon stimulation. A similar test, called a nerve conduction study, utilizes electrodes to measure median nerve response to the administration of electrical impulses. Slowed or delayed responses are generally indicative of the existence of compression in the carpal tunnel.

An individual diagnosed with carpal tunnel syndrome may undergo three to 12 months of non-surgical treatment to alleviate symptoms and re-establish normal use of the affected area. Individuals who have undergone traditional non-surgical treatment and experienced no relief may consider pursuing endoscopic carpal tunnel surgery as the next treatment option. For those who have experienced a loss of coordination or strength in their fingers or hand, or whose severe symptoms have resulted in nerve damage or impaired hand function, surgery is generally required.

There are two approaches to endoscopic carpal tunnel surgery, which is generally performed under local anesthetic. The first approach involves the use of a single incision in the wrist, known as a single-portal technique, through which the endoscope and necessary cutting tools are inserted. A two-portal technique is used when a secondary incision must be made in the palm of the hand.

During surgery, a slender, pliable tube outfitted with a tiny camera, called an endoscope, is inserted through the incision. The camera serves as an imaging aid to allow the attending physician a clear view of the interior structures of the wrist. The fibrous band of supportive tissue, known as the transverse carpal ligament, is cut to release the pressure on the median nerve. Small sutures are used to close the incision.

Individuals who undergo endoscopic surgery generally experience a brief recovery time and less pain than other types of surgery. The discomfort associated with carpal tunnel syndrome may subside immediately following surgery, or may take some time. In cases where the surgery is not performed on the individual's dominant hand, and his or her work does not involve repetitive motion or lifting, he or she may return to work in as little as three days. Recovery time may exceed four weeks and require physical therapy for individuals whose dominant hand was affected and whose work requires repetitive, excessive use.

Complications and risks associated with endoscopic carpal tunnel surgery are rare. The most common complication is the return of carpal tunnel symptoms or the temporary loss of hand functionality. In cases where the muscles and nerves were severely damaged prior to surgery, hand function and strength may not be completely restored following the operation. Other complications associated with surgery include infection and damage to the surrounding nerves and tendons.