Living with carpal tunnel syndrome can be a daily struggle. The persistent tingling, numbness, and pain in your hand and wrist can make even the simplest tasks feel monumental. If you’ve tried conservative treatments without relief, it might be time to consider a more definitive solution. At California Pacific Orthopaedics, our team of board-certified specialists in San Francisco is proud to offer endoscopic carpal tunnel release—a minimally invasive surgical option designed to get you back to your life with less downtime.
This page will walk you through everything you need to know about this advanced procedure, from what it is and why it’s done, to what you can expect before, during, and after your surgery.
Overview: A Modern Solution to Carpal Tunnel Syndrome
Endoscopic carpal tunnel release is a state-of-the-art surgical procedure designed to relieve the painful symptoms of carpal tunnel syndrome. But what exactly is carpal tunnel syndrome? It’s a condition caused by increased pressure on the median nerve, which runs from your forearm into your hand through a narrow passageway in your wrist called the carpal tunnel. When this tunnel becomes narrowed, or the tissues surrounding the flexor tendons in the tunnel swell, it puts pressure on the median nerve. The result is pain, numbness, and tingling in the fingers and hand.
Unlike traditional “open” surgery, which requires a larger incision in the palm of your hand, the endoscopic approach is minimally invasive. Your surgeon will make a small incision, about half an inch long, in the crease of your wrist. A tiny camera, called an endoscope, is then inserted through the incision. This camera displays a live feed of the inside of your wrist on a monitor, allowing your surgeon to see the structures in your wrist with incredible detail.
With this clear view, your surgeon will guide a very small cutting tool to precisely cut the transverse carpal ligament. This is the “roof” of the carpal tunnel. Cutting this ligament releases the pressure on the median nerve, providing immediate relief for many patients. Once the ligament is cut, the tools are removed, and the small incisions are closed with a stitch or two and covered with a small bandage. Over time, the ligament will heal in a lengthened position, creating more space in the carpal tunnel and preventing future compression of the median nerve.
The primary benefits of an endoscopic carpal tunnel release compared to a traditional open release include:
- Less Postoperative Pain: With a smaller incision and less disruption to the surrounding tissues, patients typically experience less pain after the procedure.
- Faster Recovery: Many patients are able to return to work and daily activities sooner than with open surgery.
- Minimal Scarring: The small incision results in a less noticeable scar.
- Quicker Return of Strength: Studies have shown that patients may regain their grip strength more quickly after an endoscopic release.
If you’re looking for a carpal tunnel specialist in the San Francisco Bay Area, the experts at California Pacific Orthopaedics can help determine if an endoscopic carpal tunnel release is the right option for you.
Why the Procedure Is Done
The decision to proceed with an endoscopic carpal tunnel release is made after a thorough evaluation by one of our orthopedic specialists. Generally a test is performed first called a Nerve Conduction Study to confirm the diagnosis and stage the carpal tunnel syndrome as mild, moderate or severe. Surgery is typically recommended for moderate to severe carpal tunnel syndrome. Some conservative treatments that can help mild carpal tunnel syndrome may include:
- Wrist Splinting: Wearing a splint, especially at night, can help to keep your wrist in a neutral position, reducing pressure on the median nerve.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen can help to reduce inflammation and relieve pain.
- Activity Changes: Modifying or avoiding activities that worsen your symptoms can provide some relief.
- Corticosteroid Injections: A steroid injection directly into the carpal tunnel can help to reduce inflammation and swelling, providing temporary relief.
If you’ve tried these treatments for several weeks or months and your symptoms persist or worsen, your doctor may recommend surgery. Other reasons to consider an endoscopic carpal tunnel release include:
- Severe Symptoms: If your symptoms are severe and interfere with your daily life, work, or sleep, surgery may be the best option.
- Nerve Damage: Your doctor may order a nerve conduction study to measure how well your median nerve is functioning. If this test shows signs of nerve damage, surgery is often recommended to prevent further, permanent damage.
- Muscle Weakness: If the muscles in your thumb are becoming weak or atrophied (shrinking), it’s a sign of advanced carpal tunnel syndrome, and surgery is usually necessary to prevent irreversible muscle damage.
At California Pacific Orthopaedics, our goal is to provide you with the most effective and least invasive treatment possible. We’ll work with you to develop a personalized treatment plan that addresses your unique needs and goals.
What to Expect: Before, During, and After the Procedure
Knowing what to expect can help to ease any anxiety you may have about your upcoming procedure. Here’s a breakdown of what you can anticipate.
Before the Procedure
Your journey will begin with a comprehensive consultation with one of our San Francisco-based orthopedic surgeons. During this appointment, your doctor will review your medical history, discuss your symptoms, and perform a physical examination of your hand and wrist. You may also undergo a nerve conduction study to confirm the diagnosis and determine the severity of your condition.
Once you and your doctor have decided that an endoscopic carpal tunnel release is the right choice, you’ll receive instructions on how to prepare for your surgery. These may include:
- Medication Adjustments: You may be asked to stop taking certain medications, such as blood thinners or NSAIDs, for a period of time before your surgery.
- Fasting: You’ll likely be instructed not to eat or drink anything after midnight on the day of your surgery.
- Arranging for a Ride: This is an outpatient procedure, meaning you’ll go home the same day. However, you will not be able to drive yourself home, so you’ll need to arrange for a friend or family member to transport you.
During the Procedure
The endoscopic carpal tunnel release procedure is typically performed in an outpatient surgery center and usually takes about 15-20 minutes, but you are generally at the surgery center in the pre- and post-op areas for a couple of hours. Here’s what you can expect:
- Anesthesia: The procedure is usually performed with a MAC anesthesia (Monitored Anesthesia Care). This is also known as twilight sedation. It is similar to the sedation used for a colonoscopy.
- The Incision: Once the anesthesia has taken effect, your surgeon will make a small incision through the crease of your wrist.
- The Endoscope: The endoscope is inserted through the incision, providing your surgeon with a clear view of the carpal tunnel.
- Releasing the Ligament: Your surgeon will carefully cut the transverse carpal ligament, releasing the pressure on the median nerve.
- Closing the Incision: The instruments are then removed, and the small incision is closed with stitches and covered with a soft dressing.
After the Procedure
Your recovery will begin as soon as the procedure is over. You’ll spend a short time in a recovery room before being discharged to go home. Here’s what you can expect in the days and weeks following your surgery:
- Immediate Post-Op: Your hand will be wrapped in a bulky dressing or a splint to protect the incisions and provide support. You’ll be encouraged to elevate your hand above your heart to reduce swelling and to wiggle your fingers to promote circulation.
- Pain Management: You may experience some pain and discomfort for the first few days. This is generally well tolerated and only over-the-counter medications are needed following the surgery.
- Wound Care: You’ll receive instructions on how to care for your incisions. It’s important to keep the dressing clean and dry. Your stitches will typically be removed in 1-2 weeks.
- Rehabilitation: Therapy is generally not needed following this surgery, you generally regain your range of motion and function with time and every-day activities. If you are particularly stiff, your doctor may recommend physical or occupational therapy to help you regain strength and range of motion in your hand and wrist.
- Returning to Activities: Most patients can return to light activities, such as typing and writing, within a few days. You should avoid heavy lifting and strenuous activities for several weeks. Your doctor will provide you with a specific timeline for returning to your normal activities, including work and sports.
The numbness and tingling you experienced before surgery may resolve immediately, or it may take several months, up to a year for the nerve to fully heal in the more severe cases of carpal tunnel syndrome It’s important to be patient with your recovery and to follow your doctor’s instructions carefully.
Your Next Steps
If you’re tired of living with the pain and limitations of carpal tunnel syndrome, the specialists at California Pacific Orthopaedics are here to help. We are a leading provider of endoscopic carpal tunnel release in the San Francisco Bay Area. Contact us today to schedule a consultation and take the first step toward a life without hand and wrist pain.
