Pillar Pain After Minimally Invasive and Standard Open Carpal Tunnel Release: A Systematic Review and Meta-analysis

Area of Science:

• Orthopedics
• Surgical Innovation
• Pain Management

Background:

• Pillar pain is a known complication following carpal tunnel release (CTR).
• Minimally invasive surgical techniques are hypothesized to reduce postoperative pillar pain.
• A comparative analysis of pillar pain incidence between standard open CTR and alternative techniques is warranted.

Purpose of the Study:

• To compare the incidence of pillar pain after standard open carpal tunnel release (CTR) and alternative surgical techniques.
• To evaluate the effectiveness of minimally invasive CTR in preventing pillar pain.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
• Searched MEDLINE, Embase, and Scopus databases for relevant studies.
• Extracted data on surgical technique, pillar pain incidence, and follow-up intervals; calculated odds ratios (OR) for pillar pain.

Main Results:

• Twelve studies were included in the analysis.
• No statistically significant difference in pillar pain was found for endoscopic, flexor retinaculum lengthening, short incision, or illuminated knife techniques compared to open CTR.
• A statistically significant decrease in pillar pain was observed between 3- and 6-months postoperatively with minimally invasive CTR (OR = 0.41, P = .02), but not at other follow-up periods.

Conclusions:

• Minimally invasive CTR techniques did not significantly affect the initial development or persistence of pillar pain.
• Standard open CTR may be associated with a longer duration of pillar pain between 3 and 6 months postoperatively.
• Pillar pain often resolves naturally within 6 months, supporting conservative management and patient education.