Carpal tunnel syndrome is a compressive neuropathy affecting the median nerve. Compressive neuropathy is characterized by a progressive injury to a nerve caused by pressure—either constant or intermittent—typically from surrounding soft tissues like muscles, ligaments and tendons. The median nerve relays nerve impulses from the hand and wrist along the arm, and it is commonly compressed at the carpal tunnel, which is formed at the wrist by the transverse carpal ligament.

When this happens, the outer covering of the nerve, called the myelin sheath, is injured due to a lack of blood flow, reducing the nerves’ ability to conduct signals. Small nerve fibers, such as those that conduct light touch and temperature, are affected by compression of the median nerve first. If carpal tunnel syndrome progresses, the larger fibers, like those that conduct impulses to muscles, can also be affected. Unfortunately, this condition is progressive: if left untreated, carpal tunnel syndrome will result in increased damage to the nerve until it no longer functions.

Who Needs It

As we get older, our tissues become less compliant and therefore are less able to tolerate transient swelling (tendonitis) which can be aggravated by wrist position while sleeping.  Sleeping with your wrists bent can cause irritation and swelling of the nerve, which will in turn increase the daytime symptoms of carpal tunnel syndrome. Furthermore, people with comorbidities like diabetes, thyroid disorders, rheumatoid arthritis and obesity are prone to carpal tunnel syndrome. Carpal tunnel syndrome can also present as a swelling-related complication of pregnancy, although it is relatively rare.

How Does It Work

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 significant improvements in recovery time with an endoscopic carpal tunnel release, there is little consensus on this. In addition, endoscopic CRT have 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 become 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. Return 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.

Watch our video on in-office carpal tunnel procedures, or read our Clinic Carpal Tunnel Release Surgery Outcomes and High-Value Care journal article to learn more.