For carpal tunnel syndrome, when is open surgery preferred over minimally invasive surgery (endoscopic), and what are the considerations?

Open surgery is preferred over endoscopic surgery in carpal tunnel syndrome in the following conditions:

1. Revision carpal tunnel release requiring neurolysis of the median nerve and transposing an ulnarly-based fat pad flap over the median nerve.
2. End-stage carpal tunnel syndrome requiring a tendon transfer to restore thumb abduction function due to complete paralysis of the abductor pollicis brevis muscle.

These procedures are more complex and require proper exposure of the median nerve.

In straightforward carpal tunnel syndrome, either method will yield similar results. The risks and benefits of each will be explained in detail by the attending hand specialist based on his or her experience.