Endoscopic Carpal Tunnel Surgery Overview
Carpal tunnel syndrome is caused by compression of the median nerve at the wrist. Nine flexor tendons run through the carpal tunnel which is shared with the median nerve, running from the forearm to the hand. The repetitive use of the median nerve can cause inflammation which compresses the nerve resulting in pain, numbness, tingling, and weakness in the hand and fingers.
The exact cause is not known, but certain factors such as congenital abnormalities, trauma, rheumatoid arthritis, obesity, and pregnancy increase the risk of developing carpal tunnel syndrome. Symptoms of carpal tunnel syndrome usually develop gradually.
Dr. Kim is one of the few Board-Certified Hand Surgeons in the area. In addition to doing 5 years of general surgery, 2 years of plastic surgery training, and a year of research in wound healing, he also completed a 1-year hand surgical fellowship at the famous Kutz-Kleinert hand institute in Louisville, KY. Dr. Kim participated in the first US hand transplant in 1999. Dr. Kim has passed the intensive examinations to obtain (CAQH) board certification in hand surgery. He is also a member of the ASSH (American Society of Surgery of the Hand). He performs many of his hand surgeries with WALANT (wide awake local anesthesia no tourniquet) which makes the procedure and recovery fast and comfortable.
Dr. Kim is the only hand surgeon in the area performing endoscopic carpal tunnel release under local anesthesia. There is usually only minimal pain from the injection of the numbing solution then the procedure is completed within 10-20 minutes. Dr. Kim performs the Chow endoscopic technique.
Endoscopic Carpal Tunnel Surgical Procedure
Endoscopic carpal tunnel surgery consists of releasing a ligament in the wrist to relieve the pressure on the median nerve. Carpal tunnel release surgery is performed in an outpatient setting with local anesthesia or light sedation. It involves releasing the pressure on the median nerve by cutting the transverse carpal ligament. The procedure may be performed as an open or endoscopic surgery.
Open Carpal Tunnel Release
In open carpal tunnel release, a hand surgeon makes a 2 to 3 cm incision in the palm directly over the carpal tunnel and cuts the transverse carpal ligament from the outside in.
Endoscopic Carpal Tunnel Release
In endoscopic carpal tunnel release, which Dr. Michael Kim specializes in, a small (less than 1 cm) incision in the wrist area is made, and a camera is used with specialized instruments to release the transverse carpal ligament from the inside out.
Both types of surgeries are very effective at improving symptoms of carpal tunnel syndrome. The advantages of endoscopic surgery include less pain, faster recovery, and earlier return to work and sports. Given the smaller incision, patients who have endoscopic carpal tunnel release can have less scar sensitivity and a lower risk of wound complications after surgery.
Endoscopic carpal tunnel release requires more specialized instruments and experience with the procedure is important to minimize the risk of complications. Studies have shown improved outcomes, fewer complications, and a lower rate of conversion to open surgery when endoscopic surgery is performed by more experienced, higher-volume surgeons, such as with Dr. Michael K. Kim.
Endoscopic Carpal Tunnel Surgery Recovery
Most patients can resume doing their daily activities within a few days after surgery. Return to more strenuous activities like sports or gym may require four to six weeks. Following endoscopic carpal tunnel release surgery, you will usually be able to go home that day. Your hand will be bandaged, and you will have to keep your hand dry for 24 hours. The operation typically results in minimal pain which can easily be controlled with simple analgesia. In most cases the sutures are removed around day 10-14.
Your return to work and usual activities will be entirely dependent on the nature of your work, and this may take up to 4 weeks. It can take up to a year to heal completely. If there is any nerve damage pre op (numbness all the time) it takes many months for the damaged nerves to regenerate and sometimes they don’t.
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