Traditional carpal tunnel release requires up to three months of recovery, leaves scars and requires restrictive bandages up to two weeks following surgery.
However, there is a shorter, less invasive carpal tunnel release surgery that takes only 10 minutes, called stitchless endoscopic carpal tunnel release.
The incision is 1 centimeter and results in minimal scarring. A local anesthetic is used and there are no bandages necessary.
Stitchless endoscopic carpal tunnel release offers no restrictions after 48 hours and a recovery time of just one week. Stitchless endoscopic carpal tunnel release results in much less pain than the traditional “open” surgery.
Dr. John T. Knight, MD, an L.A.-based hand and wrist orthopedic surgeon and director of the Hand and Wrist Institute at the D.I.S.C. Sports and Spine Center, performs the stitchless endoscopic carpal tunnel release. I asked him some questions.
Why isn’t the stitchless endoscopic carpal tunnel release more well-known?
This technique has been around since the 90’s but has become much more sophisticated.
When I first went into practice in the early 90’s I treated quite a few patients with complications from other doctors that took a weekend course and were not hand specialists.
Once the equipment has become much more refined I began doing the procedure in the recent past. I have had excellent results and a much quicker recovery than the older open procedure.
There at two common techniques: one vs. two incisions. I use the single incision which minimizes scarring.
Can you comment on infection risk with stitchless endoscopic carpal tunnel release, vs. the traditional open carpal tunnel release?
I have never had an infection with either procedure, but usually the less invasive, the less infection, as the larger wounds are exposed to the air longer. With any procedure, no matter how minor, there is always a risk of infection.
Outpatient surgery centers, like the one at D.I.S.C. Sports and Spine Center, have lower incidences of infection than a hospital, even if done in an outpatient setting.
We take extra precautions to ensure against infection, and is vitally important that any facility adhere to strict guidelines of hygiene and cleanliness to reduce the risk whenever possible.
Why don’t more surgeons utilize the stitchless endoscopy method for carpal tunnel release?
Most surgeons are creatures of habit and if they have had pretty good results with the open procedure, then they are unlikely to want to try a new technique.
Many surgeons find it difficult to learn endoscopic procedures, as it requires an ability to work with longer and smaller instruments at a distance from the structure to be repaired, or released in this case.
Are there any contraindications to the stitchless endoscopic carpal tunnel release, that would require the patient to undergo the open method?
If a patient has had a previous open release with recurrence, significant inflammatory disease such as rheumatoid arthritis, a tumor, or incomplete visualization doing it endoscopically.
Is the “local” anesthetic literally local to the hand/forearm, or is it actually a nerve block for the entire arm?
Usually we give a local injection in the palm and wrist along with intravenous sedation. This allows for a quicker recovery for the patient, who can then begin mobilization of the hand and wrist within an hour or two of the procedure.
It is not uncommon for the patient to be able to hold a glass of liquid within a relatively short time span.
When they are discharged a few hours after the procedure, the only real restriction is to avoid any lifting or intense movement for a few days, but light activities are fine within a few days.
While pain medication is prescribed upon discharge usually very little is taken, as many patients manage their pain with over-the-counter medication like Advil during the initial healing process.
If you have been diagnosed with carpal tunnel syndrome, it would be very wise to consider the stitchless carpal tunnel release when conservative methods of treatment have failed.
Dr. Knight is widely regarded as one of the most prominent hand and wrist specialists in the U.S., specializing in minimally invasive techniques for hand, wrist and upper extremity injuries and disorders.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.