Carpal tunnel surgery — which option's safest?

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Carpal tunnel surgery — which option's safest?


Peter Amadio, M.D., a Mayo Clinic hand surgeon

Both surgical procedures for carpal tunnel syndrome are very safe. There is some suggestion that the endoscopic procedure is a little bit more risky, probably because the view isn't quite so good. Looking at things like reported major complications — cutting of nerves, malpractice suits as a result of carpal tunnel surgery and information like that — suggests that there's a small increased risk, maybe one in a thousand, of some sort of problem happening during the operation with an endoscopic procedure, which may be more than what would occur with the open procedure. But again, I want to emphasize that the risk for both is very low, and the risk of overall complications for either operation during the surgery is probably 1 percent or less; even when you are adding together accidental injuries, infections, poor healing and complications of that nature.

In the longer term, there is the possibility of having to do the surgery over again, which also needs to be discussed. Now with an open procedure, it's usually fairly easy to see everything that needs to be cut to release the carpal tunnel completely. And so, the likelihood of an incomplete release is relatively small with an open procedure so that the chance of needing a second operation after an open carpal tunnel release is probably one in 500 or so; it's very low. The chance of needing a second operation after an endoscopic procedure is a bit higher, perhaps one in 100 or two in 100 or three in 100. It depends on the series that you read. But it seems to be higher, and that may again relate to the fact that you can't see quite as well. So endoscopic procedure (has) a little bit faster recovery in the first few weeks afterward, a little bit increased risk of accidental injury during the surgery, a little bit increased chance of having a second operation necessary down the road. So when you add everything together, it comes out to be a more or less equivalent package for either the open or the endoscopic procedure.

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Last Updated: 2010-04-17
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