Carpal Tunnel Surgery is Performed at the Wrist, Not the Elbow
Carpal tunnel syndrome involves compression of the median nerve specifically at the wrist level within the carpal tunnel, and surgical decompression is performed at this anatomical location—not at the elbow. 1, 2
Anatomical Clarification
The carpal tunnel is an anatomical structure located at the wrist, bounded by carpal bones dorsally and the transverse carpal ligament (flexor retinaculum) palmarly. 2 The median nerve passes through this tunnel along with nine flexor tendons, and compression occurs at this specific location—most commonly at the level of the hook of the hamate where the tunnel is narrowest. 2
Surgical Approach and Location
Surgical decompression for carpal tunnel syndrome involves releasing the transverse carpal ligament at the wrist through either open or endoscopic techniques. 1, 3
Standard Surgical Techniques:
Open carpal tunnel release uses an incision at the wrist (typically in line with the ring finger axis) to directly visualize and divide the transverse carpal ligament. 1, 2
Endoscopic carpal tunnel release utilizes a small transverse incision proximal to the wrist fold, with endoscopic visualization to release the ligament. 1, 3
Both techniques are equally effective for symptom relief, though endoscopic approaches allow patients to return to work approximately one week earlier. 1
Minimally Invasive Modifications:
Modern techniques use small incisions (transverse incision proximal to the wrist fold) with specialized instruments like grooved guides and carpalotomes to achieve wide decompression of the median nerve at the wrist level. 3 In a 20-year retrospective series of 1,568 operations, this minimally invasive wrist-level approach achieved 99.8% complete symptom remission. 3
Common Pitfall to Avoid
Do not confuse carpal tunnel syndrome (median nerve compression at the wrist) with cubital tunnel syndrome (ulnar nerve compression at the elbow) or other proximal median nerve compression syndromes. 1 While the median nerve does pass through the elbow region, carpal tunnel syndrome specifically refers to compression at the carpal tunnel in the wrist, and this is where surgical intervention must be performed. 2
Differential Diagnosis Considerations
If symptoms suggest nerve compression at the elbow rather than the wrist, consider cervical radiculopathy or other proximal nerve pathology in your differential diagnosis. 1 Electrodiagnostic studies help localize the site of nerve compression and confirm that pathology is at the wrist level before proceeding with carpal tunnel surgery. 1, 4