Modified mini-open carpal tunnel release: A technical note with patient-reported and clinical outcomes

Carpal tunnel release (CTR) is a highly effective surgical procedure, but differences in exposure (conventional open, mini-open, endoscopic) may influence outcomes. Contemporary CTR reporting prioritizes patient-reported outcomes such as the Disabilities of the Arm, Shoulder and Hand (DASH) and the Boston Carpal Tunnel Questionnaire (BCTQ), while peripheral-nerve-specific quality-of-life measures remain largely under-reported in CTR.

Is modified mini-open carpal tunnel release (mMOCTR) non-inferior to standard open carpal tunnel release in terms of clinical and patient-reported outcomes?

We describe a single-center case series of adults treated with mMOCTR using a short palmar incision, no tourniquet, meticulous bipolar hemostasis, and tactile "crisp snap" guided stepwise division of the transverse carpal ligament. Primary outcomes were DASH, BCTQ and Peripheral Nerve Surgery Quality of Life (PNSQoL) results, while the secondary outcomes were surgical complications.

Out of 224 patients (291 hands) operated for CTR during the study period, 115 patients (166 hands) fulfilled the inclusion criteria. All patient reported outcomes improved significantly. Recurrence occurred in 8 hands (2.7%), and two cases of persistent pillar pain and two wound dehiscences were noted. No vascular or neural injury was noted.

mMOCTR delivered substantial symptom, function, disability, and QoL gains, non-inferior to those of the conventional open and mini-open techniques. As a single-center, noncomparative case series, comparative multicenter studies and technical standardization across mini-open variants are warranted to confirm these findings.