Carpal tunnel release surgery involves cutting the transverse carpal ligament of the hand to reduce pressure on the median nerve in the carpal tunnel. This is the only way to permanently resolve the symptoms of carpal tunnel syndrome.
There are two surgical techniques a surgeon may consider: open or endoscopic release. Each method has its own characteristics and merits. Various factors such as the expertise of the surgeon, the preference of the patient, the cost of the operation and the medical setting (hospital or private clinic) can influence the type of operation that the hand surgeon performs on the patient.
Open Carpal Tunnel Surgery
Open release, the traditional method, is the most commonly practiced technique. This technique involves accessing and cutting the carpal ligament through a 2-inch incision located in the palm of the hand. It is done under local anesthesia and is an outpatient procedure.
The open carpal tunnel surgery is safe and effective in resolving symptoms of carpal tunnel syndrome, but patients are prone to scar tenderness and postoperative pain in the palm. This method is also associated with longer recovery.
Endoscopic Carpal Tunnel Surgery
The endoscopic carpal tunnel surgery is performed using miniature instruments, including a camera, inserted through a tiny incision made in the wrist under local anesthesia. The procedure takes a few minutes and generally does not require stitches. Unlike the classic method, the skin and muscles of the hand are not damaged
Endoscopic carpal tunnel surgery provides faster healing and is associated with less scarring pain due to the small incision made in the skin. It can be performed on both sides at the same time, allowing only one recovery period.
Expectations after Carpal Tunnel Surgery
The outcome of carpal tunnel release surgery depends on the type of carpal tunnel surgery performed – open or endoscopic carpal tunnel surgery.
Postoperative pain
After postoperative follow-up of the patients for 3 months, the researchers found that 82 % of patients who underwent open carpal tunnel surgery had postoperative pain related to the scar, compared to 52% of those who underwent endoscopic carpal tunnel surgery.
Duration of absence from work
A study evaluating this outcome in a large population showed that patients who underwent endoscopic carpal tunnel surgery returned to work 18 days earlier than those who underwent open carpal tunnel surgery (Travers 2005). The same study showed that the average time before resuming driving is 3 days after endoscopic decompression, compared to 28 days with the classic intervention.
Functional abilities
There were no significant differences between the two groups regarding improvement in sensation and strength during follow-up. This shows that both open surgery and endoscopic surgery are effective in improving sensation and motor functions of the hand after surgery.
Complications
Although the effectiveness rate of the two methods is comparable and they both have very low complication and recurrence rates, the risk of postoperative infection is higher in those who have had open carpal tunnel surgery.
Satisfaction
In general, the satisfaction rate of patients who have undergone endoscopic decompression is much higher. As part of an experiment conducted by Dr Jean-Luc Pellat, from the Hand and Upper Limb Institute of Marseille, during which 100 patients were operated on one side in a conventional manner and on the other by endoscopy, 95% preferred the endoscopic method.
| Open carpal tunnel surgery | Endoscopic carpal tunnel surgery |
|---|---|
| Increased risk of complications per 1000 surgeries | Fewer complications per 1000 surgeries |
| Slower return to work | Faster return to work |
| Période de récupération plus lente | A faster recovery period |
| Scars are larger and possibly painful | Smaller scars that are often not painful |
| Cheaper | More expensive |
| Longer duration of the procedure | Shorter duration of the procedure |
Conclusion
Carpal tunnel surgery should preferably be performed by a hand surgeon due to the complexity of the operation and to minimize the associated risks. Patients who have undergone endoscopic carpal tunnel surgery have been proven to have less postoperative pain due to scarring and return to work faster than those who have undergone open surgery.
