I saw somebody yesterday with a tiny scar across the wrist from carpal tunnel surgery. When I had my carpal tunnel release the incision was much longer and up and down on my palm. How come such a difference for the same operation?

Carpal tunnel release has come a long way in a short time. Many surgeons have moved away from the long, open incision to an endoscopic approach. In this method, a special tool is inserted underneath the skin. The operation is done using special imaging that allows the surgeon to see what's going on.

A second new method is the limited-open method. A vertical incision is still made in the palm. This allows the surgeon to see the entire retinaculum, which is cut. The retinaculum is a fibrous band of tissue across the carpal tunnel. Cutting the retinaculum takes the pressure off the median nerve.

The tiny sideways cut you saw is from the mini-open technique. A large enough opening is made to let the surgeon see the edge of the retinaculum. Then a special knifelight is used to cut the rest. Studies are being done to find out which method is best.