Carpal tunnel release is for the most part, a very successful procedure, regardless of the technique used, so long as the diagnosis is supported by clinical exam. While nerve studies are frequently diagnostic, studies may be normal up to 15% of the time. So--if you have numbness or tingling in the thumb, index, long, and part of the ring finger, and if the exam shows irritation when your median nerve is tapped at the wrist or when the wrist is flexed, then in many instances, the nerve study results may be immaterial.
I do not perform carpal tunnel release with endoscopic techniques primarily because the literature and my experience since beginning practice in 1994 have shown that outcomes are equivalent at by 6-12 weeks regardless. Most importantly,there is more risk of nerve or blood vessel injury with the endoscopic techniques. Even among experts the risk of such injury exceeds what can be expected with an open technique, during which the nerve is visualized, and safely protected. Although nerve injury is a theoretical complication with an open tiechnique, it is very rare absent an anatomical variation or revision surgery.
From my standpoint, I can provide a very favorable outcome in over 99% of patients with a small interthenar incision (see video below), while eliminating the potential for nerve injury that exists with an endoscopic tenchnique.
A cortisone shot may help in many cases, so I will frequently recommend starting with one as opposed to proceeding directly to surgery, although for more severe cases, an injection may not be feasible. (see viseo of what to expect with an injection)
After surgery, which is performed under a local with or without sedation, or a regional block in some cases, you will be in a small bandage for 1-2 weeks. Sutures will be removed at 2 weeks. In many cases a single visit with the therapist, if any, will suffice. I prohibit forceful gripping for 4-6 weeks, and in most cases return to work is possible between 2-8 weeks--often much sooner if you perform strictly sedentary work. Discomfort in the palm may last anywhere from a few weeks to 3 months.
