Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings

Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.

A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018-2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.

Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.

Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.

Prognostic IIIa.