Are you trying to weigh 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 three types of carpal tunnel surgery:

• Open carpal tunnel release surgery In this type of surgery, the doctor opens your palm to expose the transverse carpal tunnel ligament in order to cut it in half. Open carpal tunnel release surgery is the older and more widely used of the two methods. It causes more trauma. That means it results in more rehab and recovery time. But it's generally considered safer.
  
  
• Single portal endoscopic carpal tunnel release surgery The surgeon makes one small incision in your hand. Then the doctor passes an instrument which contains a camera and scalpel through the hole. This procedure is the fastest and least invasive method. That means patients recover sooner, with less complicated aftercare than the open technique. But there are certain drawbacks (see below).

• Double portal endoscopic carpal tunnel release surgery This is almost identical to the single portal technique. But instead of one hole, the surgeon makes two small incisions in your hand. The camera and scalpel pass through separate holes. This procedure is considered a "middle ground" between the single portal and the open methods. Patients recover just as soon as with the single portal technique. Aftercare is less complicated than with the open technique.

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.

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

In order to release the nerve, surgeons cut the transverse carpal ligament which holds your wrist bones together. Cutting the ligament affords more room to the median nerve.

Endoscopic surgery starts with a small incision in your wrist. Then the doctor insert an endoscope into the incision. A fiberoptic camera on the end of the endoscope can see the ligament. 

This is in stark contrast to the open technique. There, a 2-3 inch ling incision is made in the palm.

Depending on the surgeon’s skill, he or she will insert a scalpel into the same hole. This is the single portal technique.  Otherwise, he or she will make a second incision just for the scalpel. This is the double portal technique. 

The objective is the same – to slice the transverse carpal ligament in half.  When they cut the ligament, the wrist bones snap apart. This gives more room to the median nerve, relieving the pressure on it. 

With a few stitches and bandages, the operation is complete. After a 1-2 hour recovery time, you then 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). Hand rehabilitation can take months or even a year with the open technique.

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".

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. 

Your job  most likely caused carpal tunnel symptoms to erupt in the first place. 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 US national average cost for ALL carpal tunnel surgery is $7,000. Endoscopic carpal tunnel release surgery (single or double portal) costs 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% 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 50% of them complain symptoms return after two years. These patients are most definitely dissatisfied. And most end up back at square one again with pain and numbness.

About 50% of patients end up back where they began within 2 years of the surgery. Incredibly, 25% of these patients go on to have a second surgery - which has an 80% failure rate.

The American Academy of Orthopedic Surgeons published guidelines on the treatment of carpal tunnel syndrome. They tell surgeons not to perform surgery until the patient has tried every 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.

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.

Experts (including myself) are certain carpal tunnel can be brought on by  repetitive strain injury due to overuse. Some scientists even call it "overuse injury". 

So, obviously, people who do repetitive tasks with their hands tend to get carpal tunnel. But t he problem is that many people get carpal tunnel but never overuse their hands. Why this happens is unknown, and something I'm researching at this very moment.

Best of luck!

Good 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. 

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.