Effectiveness of Endoscopic versus Open Carpal Tunnel Release on Severe Carpal Tunnel Syndrome

The present study aims to evaluate the patient-reported outcomes of endoscopic carpal tunnel release (CTR) compared with open release in patients with electrodiagnostically confirmed severe carpal tunnel syndrome (CTS).

Patients with severe CTS who underwent either open or endoscopic CTR between 2017 and 2021 were included in the study, with 38 patients in the open group and 35 in the endoscopic group. Electronic medical records were reviewed for demographic and clinical data, including preoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) scores. Patient outcomes, including postoperative QuickDASH scores, were collected via telephonic survey.

At the time of surgery, the median age of patients in the open group was 61 years (interquartile range [IQR]: 54-69) and 66 years (55-76) in the endoscopic group. At a mean of 5 years follow-up, complete resolution of symptoms was reported in 34 of 38 (89.5%) cases in the open group. In the endoscopic group, all 35 cases showed complete resolution at a mean of 3 years follow-up. This difference was not statistically significant ( p  = 0.116). Preoperative to postoperative QuickDASH scores improved by a median of 33.0 (IQR: 14.0-42.1) and 34.0 (25.0-54.3) points in the open and endoscopic groups, respectively ( p  = 0.136). Minimal clinically important difference (MCID) on QuickDASH was achieved in 68.4% of open releases and 85.6% of endoscopic releases ( p  = 0.101). There were no complications in either group, and patients reported high satisfaction rates. After surgery, the length of time away from work was 9 (6-25) days in the open group and 7 (2-23) days in the endoscopic group ( p  = 0.454).

The present study suggests that endoscopic and open CTR offer similar outcomes, supporting both options as safe and effective treatment for severe CTS.