Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1548–1554 | Cite as

Endoscopic Carpal Tunnel Release Is Preferred Over Mini-open Despite Similar Outcome: A Randomized Trial

  • Ho Jung Kang
  • Il Hyun Koh
  • Tae Jin Lee
  • Yun Rak Choi
Clinical Research



The decision to perform endoscopic versus the mini-open carpal tunnel release technique is most likely left to surgeons rather than patients with idiopathic carpal tunnel syndrome.


We hypothesized that (1) at 3 months after surgery, the subjective outcomes of endoscopic release, performed on one hand, and mini-incision release, performed on the other, would not differ in patients with bilateral carpal tunnel syndrome; however, (2) each patient would likely prefer one technique over the other for specific reasons.


Fifty-two patients with bilateral carpal tunnel syndrome had one hand randomized to undergo endoscopic release and the other to undergo mini-incision release. Each patient was assessed with the Boston Carpal Tunnel Questionnaire (BCTQ) and DASH preoperatively and at each followup. Three months after surgery, the patients commented on which technique they preferred and completed a questionnaire regarding the reasons for not preferring the other technique.


The mean BCTQ symptom/function score and DASH improved similarly in the endoscopic release group and the mini-incision release group. Thirty-four patients preferred endoscopic release and 13 preferred the mini-incision technique. Scar or pillar pain was the most commonly cited factor in not preferring either technique followed by postoperative pain for the open technique and transient worsening of symptoms for the endoscopic technique.


Despite similar improvements in BCTQ and DASH scores after endoscopic and open techniques at 3 months postoperatively, the majority of our patients preferred the endoscopic technique. The most concerning reason for not preferring the other technique was scar or pillar pain.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.



We thank Bo Ram Kim RN (specializing in orthopaedics) for assessing clinical outcomes and collecting data.


  1. 1.
    Atroshi I, Hofer M, Larsson GU, Ornstein E, Johnsson R, Ranstam J. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year followup of a randomized controlled trial. J Hand Surg Am. 2009;34:266–272.PubMedCrossRefGoogle Scholar
  2. 2.
    Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473.PubMedCrossRefGoogle Scholar
  3. 3.
    Bederman SS, Mahomed NN, Kreder HJ, McIsaac WJ, Coyte PC, Wright JG. In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery. Spine (Phila Pa 1976). 2003;35:108–115.CrossRefGoogle Scholar
  4. 4.
    Bhattacharya R, Birdsall PD, Finn P, Stothard J. A randomized controlled trial of knifelight and open carpal tunnel release. J Hand Surg Br. 2004;29:113–115.PubMedCrossRefGoogle Scholar
  5. 5.
    Bryant D, Bednarski E, Gafni A. Incorporating patient preferences into orthopaedic practice: should the orthopaedic encounter change? Injury. 2006;37:328–334.PubMedCrossRefGoogle Scholar
  6. 6.
    Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini-incision blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am. 2005;30:493–499.PubMedCrossRefGoogle Scholar
  7. 7.
    Chung KC, Walters MR, Greenfield ML, Chernew ME. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg. 1998;102:1089–1099.PubMedGoogle Scholar
  8. 8.
    Cresswell TR, Heras-Palou C, Bradley MJ, Chamberlain ST, Hartley RH, Dias JJ, Burke FD. Long-term outcome after carpal tunnel decompression: a prospective randomised study of the Indiana Tome and a standard limited palmar incision. J Hand Surg Eur Vol. 2008;33:332–336.PubMedGoogle Scholar
  9. 9.
    Demirci S, Kutluhan S, Koyuncuoglu HR, Kerman M, Heybeli N, Akkuş S, Akhan G. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2002;22:33–37.PubMedCrossRefGoogle Scholar
  10. 10.
    Ferdinand RD, MacLean JG. Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: a prospective, randomised, blinded assessment. J Bone Joint Surg Br. 2002;84:375–379.PubMedCrossRefGoogle Scholar
  11. 11.
    Gerritsen AA, Uitdehaaq BM, van Geldere D, Scholten RJ, de Vet HC, Bouter LM. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg. 2001:88;1285–1295.PubMedCrossRefGoogle Scholar
  12. 12.
    Gong HS, Baek GH, Oh JH, Lee YH, Jeon SH, Chung MS. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am. 2009;91:2130–2136.PubMedCrossRefGoogle Scholar
  13. 13.
    Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.PubMedCrossRefGoogle Scholar
  14. 14.
    Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, Li-Tsang CW, Wong LK, Boet R. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074–2078.PubMedCrossRefGoogle Scholar
  15. 15.
    Kharwadkar N, Naique S, Molitor PJ. Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release. J Hand Surg Br. 2005;30:92–95.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim JK, Kim YK. Predictors of scar pain after open carpal tunnel release. J Hand Surg Am. 2011;36:1042–1046.PubMedCrossRefGoogle Scholar
  17. 17.
    Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–1592.PubMedGoogle Scholar
  18. 18.
    Ludlow KS, Merla JL, Cox JA, Hurst LN. Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther. 1997;10:277–282.PubMedCrossRefGoogle Scholar
  19. 19.
    Macdermid JC, Richards RS, Roth JH, Ross DC, King GJ. Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg Am. 2003;28:475–480.PubMedCrossRefGoogle Scholar
  20. 20.
    Mackenzie DJ, Hainer R, Wheatley MJ. Early recovery after endoscopic vs short-incision open carpal tunnel release. Ann Plast Surg. 2000;44:601–604.PubMedCrossRefGoogle Scholar
  21. 21.
    Mattioli S, Baldasseroni A, Curti S, Cooke RM, Mandes A, Zanardi F, Farioli A, Buiatti E, Campo G, Violante FS. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med. 2009;66:299–304.PubMedCrossRefGoogle Scholar
  22. 22.
    Rab M, Grunbeck M, Beck H, Haslik W, Schrögendorfer KF, Schiefer HP, Mittlböck M, Frey M. Intra-individual comparison between open and 2-portal endoscopic release in clinically matched bilateral carpal syndrome. J Plast Reconstr Aesthet Surg. 2006;59:730–736.PubMedCrossRefGoogle Scholar
  23. 23.
    Ruch DS, Poehling GG. Endoscopic carpal tunnel release: the Agee technique. Hand Clin. 1996;12:299–303.PubMedGoogle Scholar
  24. 24.
    Saw NL, Jones S, Shepstone L, Meyer M, Chapman PG, Logan AM. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg Br. 2003;28:444–449.PubMedCrossRefGoogle Scholar
  25. 25.
    Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1997;20:1477–1486.PubMedCrossRefGoogle Scholar
  26. 26.
    Thoma A, Veltri K, Haines T, Duku E. A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg. 2004;114:1137–1346.PubMedGoogle Scholar
  27. 27.
    Trousdale RT, McGrory BJ, Berry DJ, Becker MW, Harmsen WS. Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc. 1999;74:978–982.PubMedGoogle Scholar
  28. 28.
    Ucan H, Yagci I, Yilmaz L, Yagmurlu F, Keskin D, Bodur H. Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2006;27:45–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Wong KC, Hung LK, Ho PC, Wong JM. Carpal tunnel release: a prospective, randomised study of endoscopic versus limited-open methods. J Bone Joint Surg Br. 2003;85:863–868.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Ho Jung Kang
    • 1
  • Il Hyun Koh
    • 1
  • Tae Jin Lee
    • 1
  • Yun Rak Choi
    • 1
  1. 1.Department of Orthopaedic SurgeryYonsei University College of MedicineSeoulKorea

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