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Carpal tunnel surgery – classic or endoscopic

This is a condition where the median nerve is compressed in the wrist area. The median nerve and nine tendons of the finger flexors pass through this tunnel. Carpal tunnel syndrome develops when the pressure in this space increases. While the tendons are not affected by the increased pressure, the compression of the nerve will lead to very unpleasant symptoms for you.

The most common symptoms include pain in the fingers, wrists, sometimes irritation spreading to the forearms, impaired sensitivity of the fingers, sometimes described as dullness, tingling (paraesthesia) in the fingers, morning swelling and stiffness of the fingers. Difficulties can also be present at rest, but they manifest more often at night and wake the patient. Problems are worsened when cycling, driving a car, or pushing a stroller, as these activities increase the pressure on the nerve from the outside. Other problems include deterioration of fine motor skills of the fingers, weakening of the grip, sometimes objects fall out of the hand.

If you have similar problems, we recommend that you see a doctor. The diagnosis is determined based on the described difficulties and the so-called EMG (electromyographic examination). These examinations are performed by specialised neurological workplaces. They mainly determine the speed of nerve conduction and, if this speed is reduced below certain limit, nerve constriction is clearly demonstrated.

Procedure indication

If subjective difficulties are significant (tingling in the fingers, nocturnal pain, inability to work, etc.), or if the EMG finding is advanced, it is advisable to perform the procedure. The outcome is a free carpal tunnel.

Form of intervention

Mostly outpatient.

Open or endoscopic surgery?

The release of the compressed nerve is usually performed in the so-called open technique, i.e., a larger or smaller scar in the palm will be created. An uncomplicated postoperative course is very often accompanied by greater or lesser functional problems despite the good healing of the surgical wound. These are mainly characterised by pain in the scar, inability to lean on the palm, reduced strength of muscle grip (inability to open a PET bottle cap, cut with a knife, squeeze a rag, etc.) and mainly the so-called pillar pain. It is characterised by pain at the site of the surgical scar, shooting towards the thumb or little finger, or to the front of the forearm. It is caused by insufficient stability of the wrist after the intersection of the transverse ligament and other tissues of the palm. These problems can often persist for 3 to 6 months after surgery.

Most patients undergoing surgery work manually. Therefore, it is very important for them to achieve the fastest possible functional improvement and gain the ability to mechanically load the hand as soon as possible after the procedure.

The classic open procedure is performed under local anaesthesia, when the transverse ligament in the wrist is cut through from a longitudinal incision in the palm and the structures in the carpal canal are freed, i.e., the compressed nerve (median nerve) is released. A long-term incapacity for several months is not an exception. It is not related to problematic healing of the wound or postoperative complications, but to the inability to load the hand mechanically early after the procedure. Especially for manually working patients, the need for long-term sick leave is very problematic and can have significant economic consequences for them.

Recent reports show that endoscopic carpal tunnel surgery significantly reduces the risk of these complications. Endoscopic surgery reduces postoperative pain and allows patients to return to work faster. However, the long-term results after one year are comparable for both of these surgical procedures.

The endoscopic procedure is performed from a short incision on the wrist. Special instruments with a built-in camera are used to cut the ligament safely under visual control, without injuring the tissues placed above the ligament (muscles of the palm, subcutaneous tissue and skin). It is the selective release of the ligament without scarring in other tissues that enables faster convalescence and enables loading the hand manually earlier than after classic open surgery.

Postoperative course

Significant pain relief can be expected within 1-2 days. Other problems, such as numbness or reduced sensitivity of the fingers, or problems handling small objects, should disappear within a few weeks to months. If the nerve is already irreversibly affected, the function and sensitivity of the hand will not be fully recovered. Full loading of the operated limb is sometimes possible only 3 months after the procedure (depending on the nature of the work), in some cases even after a longer period. In some cases, the scar or its surroundings can be painful, even several months after the procedure.

The classic open procedure is fully covered by health insurance. However, endoscopic surgery is a bit more financially demanding than conventional surgery and the patient has to cover partial costs of the surgery.

All plastic surgeons perform open surgical procedures in our sanatorium. Endoscopic procedures are only performed by a few of them. Consult our outpatient office to find out more.

 

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