Endoscopic Carpal Tunnel Release

Imagine the median nerve is a passenger in a lift that has become too full. The nerve is being squeezed because there simply isn't enough room.

Open surgery approaches the lift from the outside.

An incision is made through the palm to expose the ligament forming the roof of the carpal tunnel. The ligament is then opened from above, creating more space for the nerve.

Endoscopic surgery allows us to go into the lift.

Using two very small keyhole incisions — one at the wrist and one in the palm — a tiny camera and specialised instruments are introduced into the carpal tunnel. The ligament is seen from underneath and released from the inside out.

The destination is the same — more room for the nerve — but the approach avoids opening the palm in the traditional way.

The palm is an important part of the hand. We use it constantly for gripping, lifting, pushing, opening jars and countless everyday activities.

Avoiding a traditional open incision through the palm can make a meaningful difference during the early recovery.

Potential benefits of endoscopic release include:

• Two very small keyhole incisions, rather than a traditional open incision through the palm
• Less disruption to the tissues of the palm
• Less early scar tenderness
• Less tenderness with gripping
• Earlier return to everyday hand use
• Earlier return to work for many patients, particularly those whose work relies heavily on their hands

Studies comparing endoscopic and open carpal tunnel release show similar long-term symptom relief and strength outcomes. The main difference is in the early recovery, with endoscopic surgery generally associated with less scar tenderness and an earlier return to normal activities.

Not necessarily.

The right technique depends on the individual patient, the severity and duration of the nerve compression, previous surgery, anatomy and any other conditions affecting the hand or wrist.

In some circumstances, an open release remains the safer or more appropriate choice. If endoscopic surgery is not appropriate, or if the anatomy cannot be adequately visualised during the procedure, the operation can be converted to an open release.

Whether the approach is open or endoscopic, the goal is the same: give the nerve more room.

Endoscopic surgery simply takes a different route — going into the lift and opening it from the inside out, rather than opening the lift from the outside.

For the right patient, this keyhole approach can mean less disruption to the palm, less scar tenderness and a faster return to using the hand.