Improved Surgical Outcomes With Endoscopic Carpal Tunnel Release in Patients With Severe Median Neuropathy

Background: Carpal tunnel syndrome (CTS) can be treated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR). Our goal was to evaluate the safety and efficacy of ECTR versus OCTR in patients with severe CTS. We hypothesized that ECTR would be as safe and effective as OCTR in these patients. Methods: This was a retrospective cohort study of patients with severe CTS who underwent ECTR or OCTR by E. G. Deune between 2001 and 2014. Variables were patient age, sex, relevant medical history, alcohol and tobacco use, and preoperative electromyography and physical examination results. The primary outcome was patient-reported resolution of neuropathic symptoms at last follow-up. Secondary outcomes were surgical complications and need for reoperation. We compared the cohorts using Student’s t tests and chi-square tests. Results: We identified 138 cases of severe CTS in 126 patients who met our inclusion criteria. Thirty-nine cases were treated with ECTR and 99 with OCTR. Mean ages were 59 years (ECTR group) and 56 years (OCTR group). The population was 68% women, and 56% of cases involved the dominant hand. The distributions of age, sex, hand dominance, presence of relevant medical history, and alcohol and tobacco use did not differ significantly between groups. Treatment completely resolved CTS symptoms in 82% of ECTR cases and 39% of OCTR cases. Complication rates (all causes) were similar for both procedures. Recurrence was observed in 2.6% of ECTR cases and 10% of OCTR cases. Conclusions: ECTR is a safe and effective alternative to OCTR for patients with severe CTS.