Treating Carpal Tunnel Syndrome

Open vs. Endoscopic CTS

An endoscopic carpal tunnel release is a surgical procedure that requires your surgeon to use an endoscope to visualize the median nerve and release the transverse carpal ligament. Unfortunately, there is no proven benefit from undergoing an endoscopic carpal tunnel release versus a mini-open carpal tunnel release. The only proven treatment for significant carpal tunnel syndrome is to release the transverse carpal ligament.

It does not matter how it is released—open, mini-open, endoscopic, or two portal (Chow) technique. While there are claims of significant improvements in recovery time with an endoscopic carpal tunnel release, there is little consensus on this. In addition, endoscopic CRT has a higher rate of recurrence due to an incomplete release of the transverse carpal ligament.

We perform a mini-open carpal tunnel release with local anesthesia for the vast majority of our patients. We have found this to be the safest and most predictable procedure for carpal tunnel syndrome by a wide margin.

“Microinvasive” Carpal Tunnel Release

Carpal tunnel syndrome is a neurological condition. The consensus approach for treating carpal tunnel syndrome once it has progressed to the point that it is moderate in severity is to release the transverse carpal ligament. Doing so requires your surgeon to divide the ligament, which takes time to heal surgically. Furthermore, there is no such thing as a non-invasive surgical procedure. By its very nature, surgery requires a trained surgeon to access, visualize and repair anatomical structures from within your body.

In recovery, the median nerve must regenerate its outer covering (the myelin sheath), which has been damaged by the compressive forces of the carpal tunnel, and the divided transverse carpal ligament must repair itself in an elongated position. Until these things occur, you will have symptoms.

After surgery, most patients can go back to clerical work in a day or two, but they will not be able to participate in heavy manual labor for about a month. However, returning to aggressive activity too early will lead to scar formation instead of healing and may necessitate a more involved surgical procedure to reverse the scarring. Carpal tunnel release surgery is one of the most common procedures performed by hand surgeons. They have additional fellowship training above and beyond a five-year surgical residency (orthopedics or plastic surgery) and should be trusted to correct this condition.

Visit the Carpal Tunnel Syndrome page for additional information, including symptoms and diagnosis details, or watch the video below.