Endoscopic Carpal Tunnel Release

When is surgery required for carpal tunnel syndrome?

Surgery is useful for all patients who didn't respond to non-operative treatment. Patients with moderate to severe symptoms and those with underlying bony deformities from arthritis or fractures are rather unlikely to respond to non-operative treatment and are usually better advised to undergo surgery. Surgery can be carried out either in the traditional open way, or via keyhole/endoscopic surgery.

How does traditional open surgery work?

Surgery has traditionally been carried out as a mini-open procedure with excellent results. This typically carried out under local anaesthetic (with the patient awake). A cut of just over one inch in length is made in the palm of the hand to allow for the safe release of the nerve. I use absorbable sutures to close the wound. The wound is then covered with a dressing and padded bandages are applied to the hand.

How does keyhole surgery work?

Mr. Fischer is one of the few surgeons in the northwest of England offering patients the option of endoscopic/keyhole surgery. Just like open surgery the procedure is carried out under local anaesthetic (with the patient awake). A small cut is made in the forearm close to the wrist. A camera is then inserted and under direct vision the nerve is then released. No sutures are required for wound closure, steri strips and a small dressing are applied, then a padded bandage.

What are the advantages of endoscopic/kehole surgery?

Compared to traditional open surgery the endoscopic procedure has several advantages:

The long-term outcomes are comparable

In the right hand the endoscopic release was carried out 4 weeks earlier, in the left hand 2 weeks earlier. Patients with bilateral carpal tunnel syndrome can choose whether to have both sides released in one sitting, or in two separate procedures.

Link to video demonstrating how the endoscopic release works:

When can patients start using their hand again following endoscopic surgery?

Patients can mobilise more or less straight away within limits of discomfort. The bulky outer bandages can be removed after 2 days following surgery. A small dressing is left in place to protect the wound while it heals. The dressing can be removed 10 days following the procedure. Following an endoscopic release there are no sutures that need to be removed. Most patients are able to use their hand for light activities straight away. Return to work depends on the patient's occupation. Patients in a desk-based job can return to work within a week or 2. In patients with a heavy manual job this can take 2-4 weeks. Endoscopic surgery offers an opportunity for a quicker recovery and quicker return to work compared to open surgery.

What are the risks and complications involved in surgery?

Generally speaking this is a fairly simple and straightforward operation, that shouldn't take more than 10-15 minutes. However, as with any operation there can be complications. The risk of complications is low and most of them are minor in nature and can be treated. There is no difference in the rate and type of complications between open and endoscopic carpal tunnel release. Common complications include scar tenderness (less so following endoscopic release), minor bleeding/bruising, infection, accidental damage to nerves/tendons or vessels nearby, persistent symptoms, recurrence and chronic regional pain syndrome.