Surgical Treatments for Carpal Tunnel Syndrome
For patients with moderate to severe carpal tunnel syndrome, or those with mild symptoms that do not respond to conservative treatment measures, carpal tunnel surgery is an effective treatment option.
Carpal tunnel surgery is one of the most common surgical procedures performed in the United States. The goal of surgery is to decrease the pressure on the median nerve by increasing the volume of the carpal tunnel. This is accomplished by cutting the transverse carpal ligament, which overlies the carpal tunnel. There are two techniques for performing this: open carpal tunnel surgery and endoscopic carpal tunnel surgery. Each technique has its risks and benefits, and both have excellent outcomes. You should inquire about your surgeon’s preferred technique, the post-surgical restrictions, and the recovery process.
Minimally Invasive Carpal Tunnel Surgery
Minimally invasive, mini-open, or minimally open carpal tunnel surgery refers to the surgical technique employing the smallest incision possible. This technique involves a single, 1 to 1.5 cm incision (see Figure 1) and utilizes special surgical instruments to cut the transverse carpal ligament. This technique has the advantages of both the open carpal tunnel surgery and the endoscopic carpal tunnel surgery. The advantages of this technique are:
- Performed in ~ 10 minutes
- Performed under local anesthesia
- Division of the transverse carpal ligament with minimal disturbance of other tissues
- Return to work the same day for most patients
- Minimal postoperative restrictions
Figure 1. Dr. Izadi’s patient after minimally invasive carpal tunnel surgery.
Endoscopic Carpal Tunnel Surgery
During endoscopic carpal tunnel release, the surgeon makes either one or two 1 cm incisions in the wrist and palm. A small video camera (endoscope) and surgical tools are inserted to visualize and cut the transverse carpal tunnel ligament (see Figure 2) as the surgeon watches on a T.V. monitor.
Both open and endoscopic carpal tunnel release have excellent and equivalent outcomes. Proponents of the endoscopic technique claim that it leads to less postoperative incision pain and an earlier return to work compared with traditional carpal tunnel surgery. However, critics of the endoscopic carpal tunnel release cite an increased rate of nerve injury and re-operation.
Figure 2. Endoscopic carpal tunnel release
Open Carpal Tunnel Surgery
Open carpal tunnel surgery is the traditional surgical approach. The surgeon makes a 4 to 6 cm incision in the wrist to expose the transverse carpal ligament. This incision allows the surgeon to visualize the anatomy and possible anomalies, thereby decreasing the risk of injury to nerves, blood vessels, and tendons (see Figure 1). It affords the surgeon full inspection of the transverse carpal ligament and the contents of the carpal tunnel. This approach provides an opportunity to explore of the carpal canal for hidden tumors or masses, such as ganglion cysts, which is not possible with the endoscopic technique.
There is better visualization, a lower risk of nerve injury, and lower re-operation rate with open carpal tunnel release when compared to endoscopic carpal tunnel release.
Figure 3. Open carpal tunnel release