In Carpal Tunnel Surgery, the Old Way May Be the Best Way
Carpal tunnel release (CTR) has traditionally been "open" surgery, done through a long incision made in the hand and wrist. Open CTR has been proven to be a safe and effective procedure. Still, surgeons have recently begun using an endoscope to do CTR. The endoscope is a tube with a tiny camera on it. It allows the surgeon to watch the inside of the wrist on a TV screen. Endoscopic CTR requires only one or two very small incisions. The theory is that smaller incisions will cause fewer problems than the long incision.

Studies comparing the two types of surgery have not come to a clear conclusion about which method of surgery is best. These authors compared patients who got open CTR to patients who got endoscopic CTR. The patients were all evaluated for pain and hand function before surgery and again one, six, and 12 weeks after surgery.

The one difference found between groups was that the open CTR patients had a weaker grip both one and six weeks after surgery. However, by 12 weeks there was no difference in grip between the two groups. No one in either group had nerve or blood vessel problems, and they reported about the same relief from symptoms. Also, both groups returned to work at about the same time.

All the patients were contacted again at least two years after surgery. Patients who had endoscopic CTR rated their satisfaction with the surgery at an average of 85 percent, while the open CTR group rated their satisfaction at 93 percent. However, the researchers note that five percent of the endoscopic group needed another surgery, compared to none in the open group. The patients who needed further surgery were very unhappy with their CTR.

The authors conclude that both surgeries are safe and effective. However, they were concerned about the number of endoscopic CTR patients who needed a second surgery. In fact, the authors report that their medical center is doing fewer endoscopic CTR surgeries partly because of these results.

The authors also note that they used the traditional long incision for open CTR, although there is a new open technique that uses a short incision in the palm of the hand. Only further study will show how the open technique using a short incision compares to traditional and endoscopic CTR.
Joy C. MacDermid, PhD, et al. Endoscopic Versus Open Carpal Tunnel Release: A Randomized Trial. In The Journal of Hand Surgery. May 2003. Vol. 28A. No. 3. Pp. 475-480.