Analysis of surgical options for patients with bilateral carpal tunnel syndrome

Bilateral endoscopic carpal tunnel release is a modality offered for the treatment of the median nerve compression neuropathy. This retrospective study compares outcomes for patients undergoing open carpal tunnel release versus bilateral endoscopic carpal tunnel release. We hypothesized that there is no significant difference in postoperative complication rates between unilateral open and bilateral endoscopic carpal tunnel release surgery.

The authors identified all patients who underwent open carpal tunnel release, unilateral endoscopic carpal tunnel release and bilateral endoscopic carpal tunnel release at a university hospital from 2012 to 2014. Cases were identified using CPT billing codes and the data was assessed using an analysis of variance (ANOVA). All endoscopic carpal tunnel releases were done by the same surgeon (AP), and greater than 90% of open procedures were done by a different same surgeon (DF).

The total combined complication rate was 24.7% with no significant difference (p > .05) between techniques. There were no major complications necessitating a return to the operating room. Variables that had a statistically significant difference between groups (p < .05) included mean tourniquet time, mean total procedure time, and return to work as determined from the number of follow-up appointments.

The study demonstrates equivocal complication profiles and decreased cost associated with bilateral endoscopic tunnel release as compared to sequential open carpal tunnel release. Endoscopic bilateral carpal tunnel release for patients with bilateral carpal tunnel syndrome offers a safe and effective alternative to open carpal tunnel release.