What is endoscopic carpal tunnel release?

Carpal tunnel release is surgery to treat carpal tunnel syndrome, a condition that causes pain, weakness, tingling, and numbing in the thumb and fingers. Carpal tunnel syndrome is caused by activities or motions that put pressure on the median nerve in the wrist.

The median nerve and the tendons that bend and flex your fingers pass through the narrow area of the wrist called the carpal tunnel. In carpal tunnel release surgery, the surgeon cuts the transverse carpal ligament, a band of tissue on the palm side of the carpal tunnel. This takes pressure off the median nerve and relieves symptoms. You will still be able to use your wrist and hand, and eventually scar tissue will form where the ligament was cut.

Your doctor may recommend carpal tunnel surgery if:

  • You have tried nonsurgical treatments for several weeks or months and your symptoms have not improved.
  • Your symptoms are severe and interfere with your daily activities.
  • Your median nerve is damaged.
  • Other tissue, such as a tumor, is putting pressure on the median nerve.

There are two different types of carpal tunnel release surgery – open, when the surgeon makes an incision in your palm, and endoscopic [EN-doh-SKAH-pik], when the surgeon does surgery through a small tube placed into your wrist.

What are the risks and/or side effects?

Although carpal tunnel release surgery is usually successful, complications can still occur. Any surgery carries the risks of allergic reaction to anesthesia, infection, and bleeding. Additional risks associated with surgery may include:

  • Injury to a blood vessel
  • Injury to the median nerve or the nerves that branch off it (very rare)
  • Return of pain and numbness to the hand

There may be other risks depending on your health, as well as the procedure chosen, so talk to your doctor about the risks, benefits, and your concerns.

What are the benefits?

The potential benefits for carpal tunnel release surgery include:

  • Decrease in pain
  • Decrease in nerve tingling
  • Decrease in numbness
  • Return of muscle strength

How do I prepare?

As with any surgery, there are a few things you can do to prepare:

  • Exercise. Our bodies tend to heal and regain function faster when they are in good physical and cardiovascular condition.
  • Medicine. Before the surgery, discuss with your doctor the medicines you are currently taking. Some may need to be stopped for a few days before your surgery.

Consult your doctor for more specific planning based on your individual health condition.

Before the surgery, your doctor will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure. You may undergo blood tests or other diagnostic tests.

In addition, you need to tell your doctor:

  • If you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
  • About all medicines you are using, including prescribed and over-the-counter medicines, herbal supplements and patches.
  • If you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting.
  • You are pregnant or suspect that you are pregnant.

How is it done or administered?

Carpal tunnel surgery is usually performed by a surgeon who specializes in treating the bones and tissues of the hands. These are some of the steps of your surgery:

  • Anesthesia. Most patients receive local anesthesia. This prevents feeling only in the area of the surgery, and lets you remain awake. You will receive other medicine to help you relax. Some patients receive intravenous (IV) anesthesia. This allows you to stay awake and communicate with your doctor, but you won’t feel or remember the surgery.
  • Cutting the transverse carpal ligament. The surgeon will cut the transverse carpal tunnel ligament to decrease pressure on the median nerve. This may be done with open or endoscopic surgery.
    • With open surgery, the surgeon makes an incision in the skin of your palm. This provides a view of the transverse carpal ligament and other tissues. Then the surgeon will cut the ligament. Open surgery leaves a bigger scar, and may require longer recovery. There may be fewer complications than with endoscopic surgery.
    • With endoscopic surgery, the surgeon makes one or two small incisions near the wrist. A tiny camera (an endoscope) is inserted and displays images of the inside of your wrist on a monitor. The transverse carpal ligament is cut from underneath. Endoscopic surgery may have faster recovery.
  • Closing the skin. The surgeon will close the skin with sutures (stitches) or staples.

What are follow-up requirements and options?

After surgery you will stay in the surgery facility until your surgeon feels it is safe for you to go home. Most patients go home the day of surgery.

  • Your wrist may be in a splint or heavy bandage for a week or more.
  • You will still be able to use your wrist and hand.
  • Your stitches will be removed 10 to 14 days after surgery. Be sure to make a follow-up appointment.

How do I care for myself at home?

When you go home, do these things to help you heal:

  • Elevate your hand above the level of your heart and move your fingers. Do this during the first 48 hours after surgery to reduce swelling.
  • Control your pain. You will have some pain and swelling after surgery. Take the pain medicine your doctor recommends exactly as directed.
  • Wear your brace or splint. If your doctor recommended a brace or splint, wear it as directed to protect your hand and help it heal correctly.
  • Do your recovery exercises. Your doctor or therapist will recommend exercises to help you build strength and motion in your hand. It’s important to do them as directed.

Use your hand for light tasks. As soon as you feel comfortable, you can drive, brush your teeth, and do normal daily activities. Don’t do heavy work with your hand for 4 to 6 weeks.

When will I know the results?

Results may vary based on your individual condition. Talk to your doctor and surgeon to get a better understanding of when you can expect to see results.

  • In most patients, pain, numbness, and tingling will be relieved shortly after surgery. Grip and pinch strength usually return by about 2 months after surgery.
  • You may have some soreness and weakness in the hand for up to 6 months after surgery. If you still have pain or weakness after 2 months, your doctor may recommend that you work with a hand therapist.
  • Complete recovery may take up to a year. If your carpal tunnel syndrome before surgery was severe, your recovery may take longer.

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