An Overview of Open and Endoscopic Carpal Tunnel Release

Over 350,000 people in the US have a carpal tunnel release done each year. Carpal tunnel syndrome represents one of the most common causes of work absence in the US each year.

The open tunnel release procedure is performed to relieve pressure on the median nerve, alleviating the pain of carpal tunnel syndrome. Normal sensation is restored typically to the hand and fingers.

The surgery is commonly performed on an outpatient basis. The surgeon creates a tiny incision between 1 and 2 inches in the palm of the hand to expose the transverse carpal ligament, which overlies the carpal tunnel.

A metal guide is placed between the transverse carpal ligament and the median nerve. A surgeon carefully cuts above the guide through the transverse carpal ligament to create more space in the tunnel. The median nerve is then free to "breathe" and subsequently regenerate with less pain and better sensation and motor function resulting.

Once the ligament is cut, the incision is closed with sutures, a splint is applied to the wrist, and the patient is usually allowed to go home as soon as the anesthetic wears off. Within a couple weeks, patients often begin hand therapy to regain lost strength and for effective pain control post-operatively.

The endoscopic technique is also performed on an outpatient basis. It is designed to create less pain and scarring from traditional open surgery and tries to provide for a shorter recovery.

The incision is smaller than the open surgery and a metal guide is inserted above the median nerve, similar to the open technique. At this point the surgeon inserts a video camera which sends images to a television monitor in the operating room. The surgeon can visualize the inside of the wrist and hand.

Using these images,, the surgeon cuts the constricting transverse carpal ligament, relieving the median nerve pressure. The instruments are removed, and the wound is closed. A splint may be applied and hand rehabilitation may be begun as with open surgery to recuperate wrist and hand strength.

Numerous studies have been done looking at outcomes of patients undergoing endoscopic carpal tunnel release versus open release. The endoscopic variety appears to provide a faster recovery to operated patients in the short term with faster relief of pain and faster improvement in functional abilities. Long term the results appear to be equivalent.

Both surgical methods have shown equal efficacy in relieving symptoms of carpal tunnel syndrome overall. Whether or not the increased cost of endoscopic surgery makes the modest benefits appropriate is unclear.