Related Experiment Video
Updated: Sep 19, 2026
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Minimally invasive vs standard open carpal tunnel release: A systematic review, meta-analysis, and trial sequential
Ahmed Khaled Almarri1, Yazan J Alalwani2, Ammar Alsayegh2
1Orthopedic Surgery Resident, Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Introduction:
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder around the world. Minimally invasive carpal tunnel release (MI-OCTR) techniques have been developed as alternatives to standard open CTR; however, the evidence comparing these approaches remains inconclusive. Our study aimed to evaluate the efficacy, safety, and perioperative outcomes of MI-OCTR versus standard open CTR.
Methods:
Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched from inception through 20 December 2025. Randomized controlled trials (RCTs) comparing MI-OCTR with standard open CTR were included. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment and trial sequential analysis (TSA) were performed.
Results:
Ten RCTs (660 randomized units) were included. No significant differences were observed for Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS), (mean difference [MD] = -0.36, 95% confidence interval [CI]: -1.07 to 0.35, P-value = 0.23, I² = 98.2%) or Functional Status Scale (MD = -0.27, 95% CI: -0.75 to 0.21, P-value = 0.19). MI-OCTR demonstrated significantly shorter incision length (MD = -2.00 cm, P-value = 0.04) and earlier return to work (MD = -9.66 days, P-value = 0.02). TSA confirmed that only 1.2% of the required information size for BCTQ-SSS had been accrued, indicating the evidence remains inconclusive.
Conclusions:
MI-OCTR and standard open CTR demonstrated similar efficacy in symptom relief, with MI-OCTR offering possible perioperative advantages. The certainty of evidence was very low for most outcomes, and TSA indicated that significantly larger trials are needed to reach definitive conclusions.
