Open or endoscopic carpal tunnel release, what is the difference?

Transcript

Let's look at the two main procedures for carpal tunnel surgery, open versus endoscopic.

But first, let's look at the anatomy that's involved. You can see here an animated picture of the carpal tunnel. The yellow slash red structure running through the carpal tunnel is the median nerve, and it's with all the tendons. But it's this tight ligament that we have to cut to open this up, let the pressure off the nerve, and get rid of the symptoms.

So first, let's look at the traditional, more older fashion, open carpal tunnel procedure. This is a five centimeter incision being made through the palm, right here, through this very sensitive skin. Retractors are going in to pull the skin and fat back. You can see the ligament being cut from the top down to open up the carpal tunnel.

This is opposed to a much smaller incision, one centimeter incision, in the endoscopic procedure, where you can see the scope going in to the carpal tunnel in this animation. And you can see we pull a blade, the, the trigger, the blade pops up, or a scalpel, opening the ligament from, in this case, the bottom up, without having to go through all this tissue here.

Now looking at this in an actual patient, let's take a look here. This is the white structure of the ligament that you just saw in the animation. You can see the actual scalpel blade lifting up and cutting the ligament. This is a shortened video, but you get the idea.

Now looking at these two procedures, both are 95% effective and work most of the time, but let's look at the very distinct differences between the two. Look at the difference in the scars between the endoscopic procedure on the left hand side and the open procedure right here. Look at the difference, the swelling associated with it, and the longer scar.

As you can imagine with the two procedures, the more minimally invasive smaller scar has a much quicker healing time, much less scarring, much less pain medicine, much less therapy afterwards, and finally it's just a band-aid over the incision compared to a splint for several weeks for the open procedure. So the difference in the two is dramatic, and recovery time about four weeks on the endoscopic, and on the other, on the more advanced open procedure, it's about three months.

Now 98% of the time when we do an endoscopic procedure this resolves, or we can do it through that approach. About 2% of the time, though, we can't see what we need to to do it safely. We're not going to take risks doing this. As a result, we convert it to the open procedure. You'll still have a good recovery, just a longer recovery.

Usually with either of these procedures, the numbness and tingling goes away instantly. If you have loss of feeling, though, that can take months to know if that's going to wake up. And if you have weakness, that may be permanent.

About three months after surgery, you can expect to have soreness in the palm. This is called pillar pain, where the ligament folds back after we cut it and you get soreness, as you can see here from this circled area graphic that shows the area of the soreness you should have. But eventually it'll dissipate.

It's important to know that there are several reasons why you may not get complete relief, or you may get no relief at all. Number one, in a very severe case, very advanced case, it, the nerve just may not wake up after the surgery. This is a small chance.

The second, and we see this too often, is a patient was misdiagnosed. The doctor gets a nerve conduction test that shows carpal tunnel syndrome, but in reality it was underlying arthritis and they didn't really have symptoms of carpal tunnel. They have the surgery, they don't, they don't get any relief, obviously.

The third is a patient that has good relief of the symptoms initially but goes back to typing eight hours a day on the computer, and the symptoms come back.

Finally, it's called a double crush syndrome. This is where you can have a pinched nerve in two places, the carpal tunnel and, very commonly, is a nerve in the neck, that can have overlapping symptoms. You have the carpal tunnel surgery, you don't get complete relief because you still got to get your neck looked at.

Thanks for joining us. For more conditions like this, or even more on this condition, visit the Hand and Wrist Institute website.