Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Versus Open Carpal Tunnel Release

  • Compressive Neuropathies in the Upper Extremity (E Shin, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Carpal tunnel syndrome is the most common compressive neuropathy encountered by hand and upper extremity surgeons. The predominant presentation includes symptomatic paresthesias in the median nerve distribution of the affected hand, frequently causing nocturnal disturbances. Surgical treatment requires division of the transverse carpal ligament, which can be performed through open and endoscopic means. Endoscopic techniques have evolved significantly since they were first introduced in the late 1980s. This manuscript reviews the literature to summarize the current state of carpal tunnel surgery.

Recent Findings

While endoscopic techniques have demonstrated superior early functional outcomes and a more rapid recovery, there are lingering concerns over the potential for nerve, vessel, and tendon injuries. These concerns have not been validated by the hand surgery literature, which ascribes similar rates of complications for both open and endoscopic surgical approaches. Moreover, patients report greater satisfaction with endoscopic surgical approaches compared with open techniques.

Summary

In summary, the debate between proponents of open versus endoscopic carpal tunnel surgery continues. While surgeons who employ endoscopic techniques appear to be in the minority, there is a plethora of evidence to suggest that both approaches are comparably safe and equally effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Botte MJ, von Schroeder HP, Abrams RA, Gellman H. Recurrent carpal tunnel syndrome. Hand Clin. 1996;12(4):731–43.

    CAS  PubMed  Google Scholar 

  2. Learmonth JR. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am. 1933;13:905–13.

    Google Scholar 

  3. Cannon BW, Love JG. Tardy median palsy; median neuritis; median thenar neuritis amenable to surgery. Surgery. 1946;20:210–6.

    CAS  PubMed  Google Scholar 

  4. Brain WR, Wright AD, Wilkinson M. Spontaneous compression of both median nerves in the carpal tunnel. Lancet. 1947;1:277–82.

    Article  CAS  Google Scholar 

  5. Phalen GS, Gardner WJ, La Londe AA. Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Surg Am. 1950;32:109–12.

    Article  Google Scholar 

  6. Phalen GS. Spontaneous compression of the median nerve at the wrist. JAMA. 1951;145:1128–33.

    Article  CAS  Google Scholar 

  7. Phalen GS, Kendrick JI. Compression neuropathy of the median nerve in the carpal tunnel. JAMA. 1957;164:524–30.

    Article  CAS  Google Scholar 

  8. Phalen GS. The carpal tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48:211–28.

    Article  CAS  Google Scholar 

  9. Phalen GS. Reflections on 21 years’ experience with the carpal-tunnel syndrome. JAMA. 1970;212:1365–7.

    Article  CAS  Google Scholar 

  10. Phalen GS. The carpal tunnel syndrome. Clinical evaluation of 598 hands. Clin Orthop. 1972;83:29–40.

    Article  CAS  Google Scholar 

  11. Okutsu I, Ninomiya S, Natsuyama M, Takatori Y, Inanami H, Kuroshima N, et al. Subcutaneous operation and examination under universal endoscope. Nihon Seikeigeka Gakkai Zasshi. 1987;61:491–8 [Jpn].

    CAS  PubMed  Google Scholar 

  12. Chow JC. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy. 1989;5:19–24.

    Article  CAS  Google Scholar 

  13. Feinstein P. Endoscopic carpal tunnel release in a community-based series. J Hand Surg Am. 1993;18(3):451–4.

    Article  CAS  Google Scholar 

  14. Shin EK, Bachoura A, Jacoby SM, Chen NC, Osterman AL. Treatment of carpal tunnel syndrome by members of the American Association for Hand Surgery. Hand. 2012;7(4):351–6.

    Article  Google Scholar 

  15. American Academy of Orthopedic Surgeons. Management of carpal tunnel syndrome: evidence-based clinical practice guideline. Published 2016. www.aaos.org/ctsguideline. Accessed 20 Aug 2019.

  16. United States Department of Labor Bureau of Labor Statistics. Days away from work highest for carpal tunnel syndrome. https://www.bls.gov/opub/ted/2001/apr/wk1/art01.htm. Published 2001. Accessed 20 Aug 2019.

  17. • Kho JY, Gaspar MP, Kane PM, Jacoby SM, Shin EK. Prognostic variables for patient return-to-work interval following carpal tunnel release in a workers’ compensation population. Hand. 2017;12(3):246–51 The purpose of this manuscript was to determine factors that contribute to time to return to work in workers’ compensation patients who have undergone carpal tunnel surgery. The average return-to-work time in this study was 12.5 weeks. Psychiatric diagnoses were the most predictive factors for delay in returning to work, followed by opioid use, chronic pain conditions, and pre-operative work status. There was no association between return-to-work and marital status, body mass index, and preoperative electrodiagnostic values.

    Article  Google Scholar 

  18. American Academy of Orthopedic Surgeons. Clinical practice guideline on the treatment of carpal tunnel syndrome. Published 2008. https://www.aaos.org/research/guidelines/CTSTreatmentGuideline.pdf. Accessed 20 Aug 2019.

  19. Scholten RJ, van der Mink MA, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;17(4):CD003905.

    Google Scholar 

  20. 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(5):444–9.

    Article  CAS  Google Scholar 

  21. Trumble TE, Diao E, Abrams RA, Gilbert-Anderson MM. Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. J Bone Joint Surg Am. 2002;84(7):1107–15.

    Article  Google Scholar 

  22. Abrams R. Endoscopic versus open carpal tunnel release. J Hand Surg Am. 2009;34(3):535–9.

    Article  Google Scholar 

  23. Beck JD, Wingert NC, Rutter MR, Irgit KS, Tang X, Klena JC. Clinical outcomes of endoscopic carpal tunnel release in patients 65 and over. J Hand Surg Am. 2013;38(8):1524–9.

    Article  Google Scholar 

  24. McCabe SJ, Uebele AL, Pihur V, Rosales RS, Atroshi I. Epidemiologic associations of carpal tunnel syndrome and sleep position: is there a case for causation? Hand. 2007;2(3):127–34.

    Article  Google Scholar 

  25. Gaspar MP, Osterman MN, Shin EK, Osterman AL, Kane PM. Sleep disturbance and response to surgical decompression in patients with carpal tunnel syndrome: a prospective randomized pilot comparison of open versus endoscopic release. Acta Biomed. 2019;90(1):92–6.

    PubMed  Google Scholar 

  26. Benson LS, Bare AA, Nagle DJ, Harder VS, Williams CS, Visotsky JL. Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006;22(9):919–24.

    Article  Google Scholar 

  27. Gerritsen AA, Uitdehaag 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(10):1285–95.

    Article  CAS  Google Scholar 

  28. Mertz K, Trunzter J, Wu E, Barnes J, Eppler SL, Kamal RN. National trends in the diagnosis of CRPS after open and endoscopic carpal tunnel release. J Wrist Surg. 2019;8(3):209–14.

    Article  Google Scholar 

  29. • Devana SK, Jensen AR, Yamaguchi KT, D’Oro A, Buser Z, Wang JC, et al. Trends and complications in open versus endoscopic carpal tunnel release in private payer and Medicare patient populations. Hand. 2019;14(4):455–61 This study compared complications and costs associated with endoscopic carpal tunnel release and open carpal tunnel release. A significantly lower percentage of patients in the endoscopic group experienced postoperative infection and wound dehiscence. Median nerve injury occurred less frequently in the endoscopic group compared with the open group for both Medicare and private payer health insurance populations. However, endoscopic surgery was more costly than open surgery.

    Article  Google Scholar 

  30. Chung KC, Walters MR, Greenfield ML, Chernew ME. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg. 1998;102(4):1089–99.

    Article  CAS  Google Scholar 

  31. • Koehler DM, Balakrishnan R, Lawler EA, Shah AS. Endoscopic versus open carpal tunnel release: a detailed analysis using time-driven activity-based costing at an academic medical center. J Hand Surg Am. 2019;44(1):e1–62.e9 In this study, the authors used time-driven activity-based costing (TDABC), a novel accounting technique, to determine procedural costs of endoscopic versus open carpal tunnel surgery. In academic medical centers employing resident trainees, the total procedural cost for endoscopic surgery was found to be 43.9% greater than the open approach. The cost difference was primarily driven by the use of a disposable endoscopic blade, direct operating room costs related to procedural duration, and physician labor.

    Article  Google Scholar 

  32. • Michelotti B, Romanowsky D, Hauck RM. Prospective, randomized evaluation of endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: an interim analysis. Ann Plast Surg. 2014;73(Suppl 2):S157–60 This manuscript explored patient satisfaction with endoscopic carpal tunnel surgery compared with open carpal tunnel surgery. The two cohorts exhibited equivalent pain scores, two-point discrimination, monofilament testing, thenar strength, and overall grip strength at all postoperative time points. However, overall satisfaction scores were significantly higher in the endoscopic group compared with the open group. No complications were recorded in either group. The authors concluded, “Although there were no differences between the groups using our study metrics, patients still preferred endoscopic carpal tunnel surgery, demonstrated by significantly higher overall satisfaction scores at the conclusion of the study.”.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 1203 Langhorne-Newtown Road, Suite 335, Langhorne, PA, 19047, USA

    Eon K. Shin

Authors
  1. Eon K. Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eon K. Shin.

Ethics declarations

Conflict of Interest

Eon K. Shin declares that he owns stock and intellectual property in Mission Surgical Innovations, serves on the scientific advisory board for In2Bones, and receives consultation payments from DePuy Synthes.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Compressive Neuropathies in the Upper Extremity

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, E.K. Endoscopic Versus Open Carpal Tunnel Release. Curr Rev Musculoskelet Med 12, 509–514 (2019). https://doi.org/10.1007/s12178-019-09584-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-019-09584-0

Keywords

Search

Navigation