What Is Carpal Tunnel Surgery?
In almost all situations, carpal tunnel surgery involves cutting ("releasing") the transverse carpal ligament on the palm side of the hand in order to relieve pressure on the median nerve in the wrist.
Carpal tunnel surgery can be performed as an open surgery (involving a scalpel and large incision) or minimally invasive endoscopic surgery (involving a narrow scope and operating equipment with a single small incision).
Depending on factors like the complexity of the surgery and surgeon/patient preference, the operation may be performed under local anesthesia, with a regional block, or under general anesthesia.
One of the factors influencing response rates (as well as the risk of complications) is the choice of surgeries. In recent years, many surgeons have turned to endoscopic carpal tunnel release as an alternative to traditional open surgery, which has been shown to require shorter recovery times and allow people to return to work sooner.
This is not to suggest that endoscopic surgery is "better" than open surgery. In the end, there are pros and cons to each that need to be weighed with your doctor, as detailed in a 2019 review published in Current Review of Musculoskeletal Medicine.
Open Carpel Tunnel Surgery
- Fewer cases of nerve, arterial, or tendon injury (0.19% vs. 0.49%)
- Fewer cases of transient neuropraxia (0.25% vs. 1.25%)
- Scars are larger and tend to be more sensitive and obvious
- Less expensive ($1,200 vs. $1,900, approx.)
Endoscopic Carpel Tunnel Surgery
- Fewer complications per 1,000 surgeries (0.59 vs. 1.69 procedures)
- Faster recovery (typically six days shorter, in comparison)
- Faster return to work (about eight days sooner, in comparison)
- Scars are smaller and tend to be less sensitive or obvious
Generally speaking, open and endoscopic carpal tunnel surgeries have similar response rates. Although the endoscopic approach allows for faster recovery times with less scarring, open surgery is associated with slightly fewer complications and costs less.
Consideration also needs to be given to the skill and experience of the surgeon. Many surgeons do not perform endoscopic surgery simply because they are skilled at performing open surgery (including so-called "mini-open" releases that use the smallest possible incision).
In fact, only around 20% of cases in the United are treated endoscopically, according to a survey conducted by the American Association for Hand Surgery.
Regardless of the approach used, the surgery is performed on an outpatient basis and usually takes around 10 to 15 minutes to complete.
A history of an adverse reaction to anesthesia may be a contraindication to carpal tunnel surgery.
Beyond that, whether or not the surgery is recommended for you largely depends on the nature of your case and the extent to which carpal tunnel syndrome is affecting you.
The American College of Orthopedic Surgeons advises against pursuing carpal tunnel surgery based on a single concern, like diminished finger dexterity. Instead, they recommend that medical history and risk factors be assessed along with symptoms and test scores to make the appropriate decision.
Carpal tunnel syndrome sometimes arises during pregnancy. Since it almost always resolves after delivery, your healthcare provider may recommend that you wait until after you give birth to see if surgery is indeed necessary.
Carpal tunnel surgery is one of the most commonly performed surgical procedures in the United States. While generally considered safe and effective, it still carries risks, some of which may make the condition worse rather than better.
Possible risks and complications of carpal tunnel surgery include:
- Median nerve injury, with symptoms ranging from transient neuropraxia (nerve pain with motor loss) to complex regional pain syndrome (chronic nerve pain affecting part or all of a limb)
- Nearby arterial or tendon damage
- Scar tenderness or pain
- Hypertrophic scar (a visibly raised scar)
- Post-operative infection
The risk of complications from carpal tunnel surgery is low (less than 0.5% of cases).