Endoscopic vs Open Carpal Tunnel Release Surgery: Which Is Right for You?

Introduction to Carpal Tunnel Syndrome and Non-Surgical Treatments

Carpal tunnel syndrome (CTS) is the most common nerve compression problem of the body and causes uncomfortable and even painful numbness and tingling of the hand. In severe or chronic cases, it can cause permanent loss of feeling in the hand and thumb function. CTS is very common and it is estimated that anywhere from 3-5% of the population will develop CTS. The assumption by many is that if you use your hands to write or type a lot that your risk goes up. The reality is that everyone uses their hand, and anyone can potentially develop CTS, but certain genders, ages, and health conditions develop it more frequently – such as women who are over 40 and/or pregnant, as well as people with obesity and diabetes. Initial treatment for CTS is bracing and injections to help control symptoms, but when symptoms are bad and interfere with daily activities and as well as disturb sleep at night, then a carpal tunnel release (CTR) may be necessary to correct the condition.

What is Open Carpal Tunnel Release Surgery?

Open CTR (OCTR) is a very common surgery that has gone through a lot of evolution over time, much like many orthopedic surgeries. Traditional OCTR requires a large cut across the wrist to release the median nerve that was otherwise pinched under the transverse carpal ligament, which is the cause of CTS. Over time with surgical innovation, led by many of the surgeons at Rothman Orthopaedics, that incision size has shrunk, making the surgery simpler and less painful. However, one of the biggest advances for CTR surgery has been the development of the “endoscopic” technique.

What is Endoscopic Carpal Tunnel Release Surgery?

Endoscopic carpal tunnel release surgery (ECTR) is a minimally invasive technique that allows your Orthopaedic Surgeon or Hand Surgeon to perform the release through a small incision at the wrist avoiding an incision in the hand. Through the small incision a small “cannula” and “camera” are introduced between the median nerve below and the tight ligament above. Through the same cannula, a small sharp cutting tool is next introduced that cuts the ligament from underneath. The benefit of this technique is not only the smaller incision but also that it avoids cutting through the more sensitive part of the hand, all the while releasing the culprit – the tight transverse carpal ligament. Perhaps the most amazing thing is that this surgery, whether performed open or endoscopic, can be performed in less than 10 minutes often curing years of numbness, pain, and sleep disruption.

Advances in Endoscopic Carpal Tunnel Release Surgery

At Rothman Orthopaedics, we have further refined the ECTR technique to now include a number of newer and even smaller endoscopic systems. Moreover, while most ECTR techniques were traditionally performed under sedation, many of our surgeons can now perform this technique under just a local anesthetic (ie, Novocaine or Xylocaine), thereby avoiding the need for preoperative blood work and other testing, eliminating fasting on the day of surgery, and avoiding an IV or sedation. Removing these standard requirements not only avoids some of the common inconveniences of anesthesia but also decreases costs for the patient. Furthermore, patients having the ECTR technique done under just local anesthesia can drive themselves in and home without the need for a friend or family member to join. Regardless of whether a patient’s ECTR technique is done under sedation or only local, the surgery and its success rate are the same.

Choosing Between Open versus Endoscopic Carpal Tunnel Release Surgery

Both OCTR & ECTR surgeries, as performed by surgeons at Rothman Orthopaedics are equally effective in delivering success using small incisions and requiring minimal recovery time. Which technique to undergo is best made in consultation with your surgeon at Rothman Orthopaedics. The good news is that once this surgery is performed, typically taking less than 10 minutes, needing a repeat CTR surgery in the future is very uncommon.

Postoperative Course after Carpal Tunnel Release Surgery

Depending on the surgeons’ individual technique and protocol, minimal time off from work is required, often no more than 1-2 days. Similarly, post-operative opioids are not generally necessary after CTR surgery, with most Rothman Orthopaedic surgeons utilizing multi-modal pain strategies that include the use of local anesthetics and common medications such as acetaminophen (ie, Tylenol) and NSAIDs (ie, Motrin, Alleve, etc). Postoperative therapy is also not routinely required after CTR surgery, but can be helpful during the recovery period on a case by case basis.

Summary

CTS is a very common nerve condition that can fortunately be treated with a minimally invasive CTR, whether performed open or endoscopically. Which technique is best for you as a patient is best determined in consultation with your surgeon at Rothman Orthopaedics. To discuss with myself or another one of the Hand & Wrist specialists at Rothman, Make an Appointment today.