Original article
Complications of Endoscopic and Open Carpal Tunnel Release

https://doi.org/10.1016/j.arthro.2006.05.008Get rights and content

Purpose: To compile the major complications of carpal tunnel surgery and compare reported complications for open and endoscopic techniques. Methods: A literature assessment was performed for published complications of open and endoscopic carpal tunnel release procedures; 80 publications, representing a period from 1966 through 2001, were reviewed. Complications were identified as neurapraxia; nerve, tendon, or artery injury; and wound infection or dehiscence that required antibiotics or additional operative care. Differences in the proportions of complications between carpal tunnel release procedures were explored with the use of Fisher exact tests. Results: The literature review yielded 22,327 cases of endoscopic carpal tunnel release and 5,669 cases of open carpal tunnel release. For structural damage to nerves, arteries, or tendons, the incidence for open carpal tunnel release is 0.49% and for endoscopic methods (transbursal and extra-bursal), 0.19%. This difference is statistically significant (P < .005; 2-tailed Fisher exact test) and suggests that the overall proportion of structural complications for open carpal tunnel release according to our complication selection criteria is greater than the overall proportion of complications for endoscopic carpal tunnel release. Conclusions: The proportion of complications for carpal tunnel release, performed through an endoscopic or open approach, is very low. Selection of an open versus an endoscopic approach on the basis of structural complications for nerve, arteries, or tendons is not supported by statistical analysis of published complications. Level of Evidence: Level III, retrospective comparative therapeutic study.

Section snippets

Methods

A Medline search was performed of literature from 1966 through 2001 to evaluate the complications of OCTR and ECTR. An attempt was made to identify all articles pertinent to carpal tunnel surgery. Keywords for the search included carpal tunnel, open carpal tunnel, endoscopic carpal tunnel, and complications. The articles selected for inclusion in this study were those that delineated complications of surgery for a series of patients who had undergone carpal tunnel release by any means. Only

Results

Of 68 articles that met inclusion criteria, 36 reported on 22,327 ECTR cases and 32 reported on 5,669 OCTR cases. Total numbers and types of complications for each surgical procedure are listed in Table 2. Transient neurapraxias are reported in 1.45% of ECTR cases and in 0.25% of OCTR cases. Major nerve injuries are reported in 0.13% of ECTR cases and in 0.10% of OCTR cases; digital nerve injuries are reported in only 0.03% of ECTR cases and in 0.39% of OCTR cases. Tendon injuries are noted in

Discussion

This study shows that the endoscopic approach to carpal tunnel release is not more likely to produce structural injury to tendon, arteries, or nerves than the open approach. From a clinical relevance standpoint, many reasons may be suggested for why some surgeons prefer an open approach over an endoscopic approach, but these data would reveal that safety for the endoscopic approach is comparable to that for the open method. Indeed, damage to median or ulnar nerves was not statistically

Conclusions

On the basis of studies published since 1966 on the open technique and studies published since 1989 on the endoscopic method, the percentages of structural complications to nerves, arteries, or tendons are 0.49% for the open approach and 0.19% for the endoscopic approach (via a transbursal or extrabursal method). The incidence of injury to the median or ulnar nerve with the open endoscopic approach is not statistically significantly different and corresponds to an incidence of approximately 1

Cited by (142)

  • Intraoperative Conversion From Endoscopic to Open Carpal Tunnel Release: A Systematic Review and Case Series

    2023, Journal of Hand Surgery
    Citation Excerpt :

    In these cases, the neuropraxic injury may be attributable to unsuccessful attempts to gain adequate visualization during ECTR. Other authors have similarly identified higher rates of transient neuropraxic injury in ECTR when compared with OCTR.2,6,23 This investigation has several limitations that should be considered.

View all citing articles on Scopus

The authors report no conflict of interest.

Note: To access the supplementary table accompanying this report, visit the September issue of Arthroscopy at www.arthroscopyjournal.org.

View full text