Endoscopic surgery has become the gold standard for the surgical treatment of carpal tunnel syndrome. While the actual procedure has merits, it is not the panacea of popular belief. The rush to have unnecessary carpal tunnel surgery has come under considerable scrutiny lately; thus the factors to consider for having unnecessary carpal tunnel endoscopic surgery must be weighed carefully.
The US Bureau of Labor and Statistics and the National Institute for Occupational Safety and Health report that carpal tunnel syndrome is the second most common type of musculoskeletal surgery in the USA, with over 230,000 unnecessary procedures performed annually.
The surgical approach to alleviate carpal tunnel syndrome has conventionally been “open release” surgery. But increasingly more surgeons are using endoscopic surgery which among other advantages is less invasive and requires less recovery time.
Yet many people and doctors alike fail to weight all of the advantages of endoscopic surgery against those of non-surgical therapies. This article will list the pros and cons of endoscopic surgery for carpal tunnel syndrome.
Considerations for Surgery
Surgeons consider a patient a candidate for endoscopic carpal tunnel surgery the same way they do for carpal tunnel open release surgery; if you have carpal tunnel syndrome you need surgery.
What Endoscopic Surgery Involves
Endoscopic surgery means that an endoscope is used to see inside the carpal tunnel rather than opening the tissue over the carpal tunnel completely. The surgery uses a thin, flexible tube containing a camera guided through a small incision in the wrist or through both the wrist and palm (single-portal and two-portal techniques, respectively). This gives the surgeon a view of the carpal tunnel and all of the tissues surrounding and the ability to cut tissues inside without having to make big incisions.
During surgery, the endoscope shows the surgeon the transverse carpal ligament, which is cut using a small cutting tool also passed through the endoscope. In the two-portal technique, the camera is passed through one tube and the cutting tool in the other. In the single-portal technique, all instruments pass through one tube.
The ligament is cut and pressure is relieved from the median nerve. Any incision is then closed with stitches, and the gap left where the ligament was cut will fill with scar tissues. Generally, the patient can go home the same day.
What to Expect After Surgery
The advantage of endoscopic surgery compared to open release surgery, is that there is a little faster recovery time since it avoids cutting the palm open to expose the ligament. Another advantage is that the surgical scar is smaller.
The symptoms might be alleviated immediately after surgery. However, in many patients it takes several months. In other patients, the symptoms subside only a little, not at all, or increase in intensity with new symptoms such as loss of hand grip.
Every patient must avoid heavy use of the hand for a few weeks. Return to work depends on several factors such as whether it was your dominant hand, the type of work involved (jobs involving constant typing or using heavy equipment/tools take longer), as well as the effort one puts into rehabilitation of the hand and doing physical therapy.
With surgery on the non-dominant hand, generally patients can return to work in 2 days if the word does not involve repetitive hand work. If the surgery is on the dominant hand, and if the work is repetitive and stressful, return to work may take a month or more. All of this depends on the amount of physical therapy involved and an individual’s own speed of recovery.
Effectiveness of Endoscopic Surgery
The effectiveness of endoscopic surgery for carpal tunnel syndrome is the most often discussed matter and the source of considerable debate. This often is the most crucial aspect of deciding to have surgery versus non-surgical treatment.
The most common complication of surgery for carpal tunnel syndrome is the return of symptoms. This may occur shortly after the surgery or up to a year later. Loss of grip strength (or strength when pinching an object) is another common complication.
Risks and Downside of Endoscopic Surgery
Aside from specific risks of endoscopic surgery for carpal tunnel syndrome, all surgery carries with it some general risks. These include infection at the site of surgery or systemic infections, as well as risks of a reaction to general or local anesthesia. This carries with it a risk of death, although that’s rare.
Risks specific to endoscopic surgery for carpal tunnel syndrome include major problems such as nerve damage are about 1%. There also is the risk of injury to blood vessels and tendons. Scar tissue also may build up over time, creating more pain and symptoms than before the surgery. This might require a second surgery to repair. Finally, while not a risk per se, a simple unsuccessful result (meaning the surgery just didn’t work for some reason) is possible.
Even if the surgery is “successful”, and it takes you 1 month to fully recover, during that time (and for months thereafter) you must slowly start stretching and building up your strength, being careful not to re-injure yourself. That’s a lot of time, and a lot of work, that some patients cannot afford.
Finally, surgery often fails to take into account that a larger carpal tunnel syndrome dynamic leading to the symptoms in the first place. Just cutting one spot may not beneficially affect that dynamic. So with failed results, a surgeon will often say that you just need a second surgery.