[Choice of procedure in therapy of distal median nerve compression syndrome]

Endoscopic carpal tunnel release is frequently recommended. This technique allows only for division of the retinaculum flexorum, but does not enable the surgeon to address concommitant synovialitis or compression of the motor branch of the median nerve. In 67 patients, we attempted to differentiate the indications for procedures by endoscopic versus open carpal tunnel release. Beside an electrophysiological investigation, sonography of the wrist was performed to evaluate the extent of accompanying tenosynovialitis of the flexor tendons. A possible participation of the thenar branch was examined by electromyography. If there were no additional pathologic findings in the preoperative diagnostic work-up, a simple carpal tunnel release was performed. In all other cases, open surgical release was performed.