Endoscopic carpal tunnel surgery

Endoscopic surgery uses a thin 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 too 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 and relieves carpal tunnel syndrome symptoms.

The small incisions in the palm are closed with stitches. Over time, the gap where the ligament was cut will fill with scar tissue.

If you have endoscopic surgery, you probably won't have to stay in the hospital. You can go home on the same day.

Endoscopic carpal tunnel release surgery is considered when:

• You still have symptoms after a long period of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you still have symptoms but there's no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict your normal daily activities.
• There is damage to the median nerve (shown by nerve test results and loss of hand or finger function) or a risk of damage to the nerve.

A person who is having surgery on both wrists, or who depends on a wheelchair, a walker, or crutches, may choose endoscopic surgery. That's 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.

In rare cases, the symptoms of pain and numbness may come back. (This is the most common complication.) Or you may have a short-term loss of strength when you pinch or grip an object.

If the thumb muscles have been severely weakened or gotten smaller, your hand strength and function may be limited even after surgery.