Surgical therapy for carpal tunnel syndrome is superior to conservative therapy. Decompression of KTS is one of the most common operations worldwide.
Indications (areas of application)
- Persistent sensory disturbances
- Therapy-resistant nocturnal pain (brachialgia paraesthetica nocturna) or paresthesias with sleep disturbances.
Surgical procedure
- Open splitting of the retinaculum/retaining ligament (with or without neurolysis/surgery to remove the constrictions of a nerve) [Surgical therapy of choice; success rate: 93.4%].
- Endoscopic splitting of the retinaculum after:
- Agee – endoscopic cleavage of the retinaculum via an incision in the proximal transverse wrist flexor crease (monoportal technique) [surgical therapy of choice; success rate: 93.4%]
- Chow – Split retinaculum with two approaches, the proximal transverse wrist flexor crease and palm (biportal technique; success rate: 92.5%).
The complication rate is less than 1% for experienced surgeons. See more under Operations under “Orthopedics and Trauma Surgery”.
Open surgery versus endoscopic surgery
- Grip and pressure (pinch) force greater in the early phase after endoscopic surgery than after open surgery; similar after six months
- Shorter operation time with the endoscopic method (only 5 minutes on average).
- Rare pain and tenderness of the scar after endoscopic procedures.
- Nine days earlier back to work after endoscopic procedures
- Threefold increased risk of transient nerve injury during endoscopic procedures
See more under surgeries under “orthopedics and trauma surgery”. Further notes
- Long-term outcomes of carpal tunnel splitting in patients with bilateral severe carpal tunnel syndrome: assessed with the Boston Carpal Tunnel Questionnaire (BCTQ), there was no long-term discomfort, nor functional limitation in 72.5% of hands. When the procedure was performed endoscopically, long-term outcomes were consistently better.
