Carpal Tunnel Syndrome - Surgery

Endoscopy. Endoscopy for carpal tunnel syndrome is a less invasive procedure than standard open release.

One or two 1/2-inch incisions are made in the wrist and palm, and one or two endoscopes (pencil-thin tubes) are inserted.
A tiny camera and a knife are inserted through the lighted tubes.
While observing the underside of the carpal ligament on a screen, the surgeon cuts the ligament to free the compressed median nerve.

Patients report less pain and return to normal activities earlier (about half the time) than those who had the open release procedure. Nevertheless, at this time the best evidence available does not show any significant long-term advantages of endoscopy over open release in terms of muscle or grip strength or dexterity. The endoscopic approach may even carry a slightly higher risk of pain afterward. This may be due to a more limited view of the hand with endoscopy. (In the open release procedure, the surgeon has a full view of the structures in the hand.) One report indicated about a 3-fold increased risk of reversible nerve injury with endoscopic carpal tunnel release than with open carpal tunnel release.

Postsurgery Recovery

Timing for Recovery. Patients should expect the following course:

For some patients, release surgery relieves CTS symptoms of numbness and tingling immediately.

People who have the operation on both hands are completely incapacitated for about two weeks and must have someone to help them at home.
Returning to strenuous work right after surgery may cause the symptoms to recur. Patients generally stay out of work for at least a month and often much longer, depending upon the type of surgery and severity of the condition. (Recovery time appears to be faster with endoscopy than with open release.)
Immediately after surgery, however, patients usually experience a decline in grip strength and dexterity. Studies have reported a wide range of recovery in this area. In one, grip and pinch strengths exceeded preoperative status within six weeks. In another, however, grip strength and dexterity did not return to pre-operative levels until 25 weeks after open surgery, and the scar may remain tender for up to a year.
Peak improvement may take a long time; in one study it took an average of almost ten months.

Physical Therapy. Physical therapy is very important to help rebuild wrist strength. While physical therapy does not reduce the recurrence of symptoms or improve the long-term benefits of surgery, it does accelerate postsurgical recovery. Hand exercises can help restore circulation, muscle strength, and joint flexibility in the hand and wrist. (Wearing a splint to immobilize the wrist after surgery confers no benefits.)