Are you weighing the pros & cons of endoscopic surgery for carpal tunnel syndrome? Here you'll find an easy-to-understand discussion about carpal tunnel syndrome and all the advantages and disadvantages of this surgical procedure. In the end you'll be better equipped to make the smartest decision concerning your hand and your health.

Your doctor will recommend one of the three basic types of carpal tunnel surgery described below. (Note, some of these can be modified by the doctor.) The recommendation usually is based upon the surgeon's comfort and experience with one particular type of surgery.

While this is the most-asked question by patients, sadly there isn't an easy answer. The best answer is, "It depends on the doctor's preference and patient's needs."

The pros & cons of endoscopic surgery for carpal syndrome were hotly debated since the early 2000s. Even so, the relative ease and additional profitability of the endoscopic procedure (single or double portal method) is making it a winner in the minds of doctors today. The trend toward the endoscopic technique is fast overtaking the open technique in terms of popularity with doctors and patients. That's primarily driven by the relatively less pain and shorter aftercare and recovery times involved.

You acquire carpal tunnel syndrome because your flexor tendons inflame and swell inside your wrist joint. (Generally, overworking the fingers leads to the inflammation.) The swelling pushes on your median nerve, ultimately crushing it. This causes all the main carpal tunnel symptoms like pain, numbness, tingling, shooting electric shocks, and weakness. 

Rather than treating the inflammation, surgery merely "makes more room" inside the wrist joint. In other words, surgery "releases" the median nerve from being crushed by surrounding tendons. Cutting the ligament makes your wrist bones snap apart. This affords more room for the median nerve. More room means that the pressure on the nerve is relieved. 

In order to release the nerve, all types of surgery require the surgeons to cut the transverse carpal ligament. This thick tissue band holds your wrist bones together.

Endoscopic carpal tunnel surgery

Endoscopic carpal tunnel surgery starts with one or two small incisions in your wrist. In the single portal technique the doctor inserts an endoscope and scalpel into the same incision. In the double portal technique the doctor makes a second incision just for the scalpel. In either method, a fiberoptic camera on the end of the endoscope lets the doctor see the ligament before cutting it. After closing the holes with a couple stitches, you can go home after 1-2 hours.

Open carpal tunnel surgery has a major difference compared to the endoscopic technique. In the open technique, the doctor makes a 2-3 inch long incision in the palm. The objective is the same – to slice the transverse carpal ligament in half. The skin is closed with more stitches than the endoscopic method. After a 1-2 hour recovery time, you can go home.

Considering all the pros and cons of endoscopic surgery for carpal tunnel, the most significant advantage is the lesser trauma produced compared to the open release method.   

Before single or double portal endoscopic surgery was developed, all doctors used the "open release" technique.  But the main problem is the open technique requires a 2-3 inch long cut on your palm. That means muscles and blood vessels are interrupted and even damaged. 

As a result of the extensive tissue trauma with the open technique, there's much more post-operative pain. This translates into more extensive aftercare and longer recovery time after surgery (sometimes taking months). With the open technique, hand rehabilitation can take months or even a year.

In contrast, the endoscopic method (single or double portal) reduces these problems significantly. Recovery is faster, aftercare is easier, and rehabilitation time is shorter. Moreover, there's much less post-surgical pain.

When patients weigh all the pros and cons of endoscopic surgery for carpal tunnel surgery, they consider having less pain as the major "pro".

As discussed above, the less extensive trauma resulting from endoscopic surgery means faster post-operative recovery. Patients usually see stitches removed in a week. The surgical pain is almost gone within 2 weeks.

In contrast, with the open technique, postsurgical pain usually persist longer. Generally, it takes several weeks for pain to subside. Sometimes it can take months.

Most (single or double portal) endoscopic surgery patients can return to work within a month. This compares to the open technique, which requires 2-3 months before returning to work. Either way, when you resume any work you must refrain from extensive hand and finger use. This is particularly the case if the surgery was on your dominant hand.

Your job most likely caused carpal tunnel symptoms to erupt in the first place. Certain harmful hand activities are known to correlate with getting carpal tunnel syndrome. Thus, going back to the same job is therefore not advised by doctors. In fact, only 10% of workers who had carpal tunnel surgery go back to their former job. The others had to find other employment or else another job function with the same employer.

The open technique results in a 2-3 inch long scar on your wrist. But with endoscopic surgery you may have one or two tiny scars instead. This isn't only a cosmetic advantage to endoscopic surgery. Scar management is important after surgery. The scar(s) left behind after the endoscopic technique require much less attention (see photos).

The US national average cost for ALL carpal tunnel surgery is about $7,000. Endoscopic carpal tunnel release surgery (single or double portal) costs about 44% more than open release surgery. Also, carpal tunnel surgery costs vary greatly from state to state. (See your state's average cost here.)  

The reason for the higher cost is the extra skill and training that goes into performing both types of endoscopic carpal tunnel release surgery. The instruments used are also more specialized and therefore more expensive.

However, the higher surgical cost of endoscopic surgery may be offset by lower rehabilitation costs. This surgery will likely require fewer physical therapy sessions. That translates into a lower cost overall. 

Most doctors describe both endoscopic techniques as a safer surgery, but it's not without risks. The most serious risk of (single or double portal) endoscopic carpal tunnel surgery is nerve injury. Why?

In the open technique, it's easy to expose and see the median nerve and its branches. But when using a camera in the endoscopic technique, the visibility isn't as good. As a result, there's a 1-2% chance the median nerve or its branch can be nicked by mistake. This could result in some loss of hand or finger function. 

Another downside to endoscopic surgery is that symptoms may never resolve. However, the chances of that are equivalent to the open technique. So are the chances of recurring pain, excessive bleeding, and infection.

The slightly higher risk of nerve injury makes considering the pros and cons of endoscopic surgery for carpal tunnel more compelling.

Only 20-25% of surgeons use the endoscopic technique (single or double portal) for carpal tunnel surgery. The reason is due to the more complex and extensive training required for this technique. 

The open technique is straightforward and requires no special equipment. But the endoscopic techniques require an expensive endoscope and other instruments. Also, there are special cutting tools from various medical device companies the surgeon can choose from (once he or she trains how to use them). 

You can weigh all the pros and cons of endoscopic surgery for carpal tunnel. But in the end it will be your doctor's choice to use one of the endoscopic or open techniques on you. It depends on what he or she feels comfortable with. 

That means you may have to shop around for a surgeon who performs the technique YOU desire.

More importantly, the pros and cons of endoscopic versus open release surgery must be weighed against "having surgery" in the first place. That's because the  overall "success rate" of carpal tunnel surgery is not fantastic.

Actually, your  doctor's definition of surgical success is whether or not the transverse carpal tunnel ligament was "severed without complications". That accounts for all the glowing statistics for the effectiveness of the operation. 

But from the patient's perspective it’s an entirely different story. Patients care about satisfaction with their results. Most patients are fine for the first 6 to 12 months. But about 56% of them complain symptoms return within two years. These patients are most definitely dissatisfied. And most end up back at square one again with pain and numbness.

Most of these patients end up back where they began within 2 years of the surgery. Incredibly, less than 5% of these patients go on to have a second (called "revision") surgery - which has an 80% failure rate.

The American Academy of Orthopedic Surgeons published guidelines on the treatment of carpal tunnel syndrome. They advise surgeons to not perform surgery until the patient has tried every approved non-surgical treatment for at least 6 months. 

That's because there are many non-surgical methods that work as well as surgery – some, even better. For example, steroid injections help relieve symptoms in approximately 45% of patients. Also, myofascial release therapy (a specialized massage) permanently relieves symptoms in approximately 97% of patients. Combine these with nocturnal bracing and core stretching exercises creates a powerful tool for fighting carpal tunnel.

Carpal tunnel syndrome is a permanent and incurable condition. But its symptoms can be reversed. (That's assuming you use the proper treatment.) It's not a "cure" but it's close. 

In this respect, carpal tunnel is like type 2 diabetes. Type 2 diabetes can't be cured. But it can be naturally reversed through diet and exercise.

Likewise, studies prove carpal tunnel can also be naturally reversed. The  specialized physical therapy technique called myofascial release usually can eliminate carpal tunnel symptoms.

In short, whether you have diabetes or carpal tunnel, you can manage symptoms very well with therapy. But you’ll always be predisposed to symptoms returning because neither can be cured.

Experts are certain carpal tunnel can be brought on by repetitive strain injury due to overuse. Some scientists even call it "overuse injury". There are particular hand stresses that are harmful - even dangerous - when performed routinely.

So, obviously, people who perform stressful activities with their hands tend to get carpal tunnel. But the problem is that many people get carpal tunnel but never overuse their hands. Why this happens is unknown, and something research is trying to answer.

Best of luck luck with weighing all the pros and cons of endoscopic surgery for carpal tunnel. And best of luck with whichever way you decide to take care of your hand's problems. The pros & cons of endoscopic surgery for carpal tunnel syndrome are many. You and your doctor should discuss the risks and benefits of having it. Whatever your decision, always keep in mind that surgery is not a "cure" for carpal tunnel syndrome. Surgery is only one type of treatment because carpal tunnel is a disease without a cure. Today, most doctors are opting for non-surgical treatments to relieve symptoms. These include night bracing, hand & finger exercises, and myofascial release massage. All work extremely well in most patients to manage this condition.