Open Versus Endoscopic Carpal Tunnel Surgery | Dr. Daniel Gould

Dr. Daniel Gould co-authored this research published in The Journal of Hand Surgery, examining the considerations involved in choosing between open and endoscopic techniques for carpal tunnel release.

Carpal tunnel release is a common surgical procedure used to relieve compression of the median nerve at the wrist. Both open and endoscopic approaches can provide effective treatment, but each technique offers different considerations related to visualization, recovery, anatomy, and potential complications.

The authors reviewed the existing evidence comparing open and endoscopic carpal tunnel release while also drawing on more than 70 years of combined surgical experience within their academic practice.

A particular focus of the article is the anatomical variation that surgeons may encounter within the carpal tunnel. Variations involving the median nerve, thenar motor branch, tendons, blood vessels, and other structures can complicate surgery and increase the importance of clear visualization.

The authors also present clinical examples involving nerve injuries, tenosynovitis, calcific tendinitis, amyloidosis, cysts, and other findings that may be difficult to identify or address through an endoscopic approach.

Based on these anatomical considerations and their surgical experience, the authors explain why they favor offering open carpal tunnel release in many cases, highlighting the importance of selecting a surgical approach based on individual anatomy and clinical circumstances.