Carpal tunnel may be the most commonly known hand procedure out there, but this highly performed surgery has changed a little over the years. While most providers still perform a standard, open carpal tunnel release, some surgeons have started performing the procedure endoscopically. Here, we’ll outline the differences between the two surgery styles so you can assess which one might be right for you.
How are the procedures different?
First you might be wondering what endoscopic surgery is? Endoscopic surgery is basically a procedure that is performed by sending a camera and instruments through a small tube, rather than totally opening the surgery site. Both open and endoscopic carpal tunnel releases complete the same task; they alleviate pressure on the median nerve, reducing numbness, tingling and pain. Though they may seem very different, there are minimal differences in the way these procedures are performed. Because of the nature of the surgery, open surgery produces a larger scar (roughly 2-3cm) than endoscopic (1cm or less). Both procedures have roughly the same surgery time and require the same anesthesia. The dressing is often smaller with endoscopic surgery as well.
When it comes to recovery time, both procedures take about 2 weeks for the incision to heal. Open surgery may include some discomfort for up to 2 months, compared to up to 2 weeks with endoscopic surgery. However, occupational therapy and casting or dressing routines are often the same. Since endoscopic carpal tunnel surgery can lead to shorter recovery time, it tends to be the preference of those still in working age, as it may get them back to work sooner. However, overall outcomes tend to be the same, no matter which way you have the procedure.
Pros and Cons to both procedures
Endoscopic surgery generally results in a smaller incision, faster recovery time and possibly less pain that open procedures. However, there are some drawbacks. Depending on the need, not every patient is a good candidate for an endoscopic carpal tunnel release. Anatomy, severity of symptoms or if carpal tunnel is a secondary issue could affect your chances of having endoscopic vs open carpal tunnel surgery.
On the flip side, open carpal tunnel surgery may lead to longer heal times and larger scarring. However, during open surgery, more than one procedure can be performed at a time (if necessary), such as removal of a growth. For those that require a carpal tunnel revision, or those who have recurrent carpal tunnel, endoscopic is not an option for you, so an open procedure would be necessary.
So why isn’t endoscopic Carpal Tunnel Surgery performed more often?
- Surgeon preference – every doctor likes something different. They know what works best for them and their patients based on their years of experience.
- Not everyone is a candidate – since there are limitations to the procedure, it won’t work for everyone.
- Possible additional training/ exposure – since endoscopic carpal tunnel surgery is a relatively new technique, some surgeons may not have had the proper training or exposure to this style; and even if they have, open surgery has been their tried and true for many years. So if it ain’t broke, don’t fix it!