Patients who have endoscopic surgery report less pain than those who have the open release procedure, and they return to normal activities in about half the time. Nevertheless, at this time the best evidence available does not show any significant long-term advantages of endoscopy over open release in terms of muscle, grip strength, or dexterity. The endoscopic approach may even carry a slightly higher risk of pain afterward. This may be due to a more limited view of the hand with endoscopy. (In the open release procedure, the surgeon has a full view of the structures in the hand.) Because of this reduced visibility, there are more concerns about irreversible nerve injury with endoscopic carpal tunnel release than with open carpal tunnel release. However, larger studies have shown an extremely low number of complications when the procedure is performed by experienced physicians.
The injection site is just above the wrist. In fact, exactly where you put it seems to make no difference to how effective it is as long as you are within a couple of inches of the carpal tunnel so most people now choose an injection site for both comfort and safety - which usually means about 1-2 cm up the arm from the wrist crease. The patient experience following injection is heavily modified by whether a local anaesthetic is included in the injection. If you do inject an anaesthetic as well as a steroid then you get exactly the same effect which is familiar to most people from dental anaesthetics - numbness of the affected area for a few hours afterwards. There has however never been any real logic to adding a local anaesthetic to this injection. It is certainly not there to influence the pain of the injection itself as the procedure is all over before the local anaesthetic has any chance to take effect. I have heard it argued that numbness in the median nerve territory after injection including anaesthetic proves that you got the injection in the 'right' place, but, as pointed out above, it makes no difference to the outcome where you put it so why does anyone care? We do not include a local anaesthetic.
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