Carpal Tunnel Release Review Summary

A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Tunnel Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Release

Background: Compared to the open technique, endoscopic carpal tunnel release has a shorter post-operative recovery period but has been associated with an increased risk of iatrogenic injury. Due to morbidity of the open method including painful scars, pillar pain, tendon adhesions, scar entrapment of the median nerve, chronic regional pain syndrome and a longer post-operative recovery period, many patients previously have been treated non-operatively to circumvent or forestall surgery, resulting in unrelieved median nerve compression and an increased risk of permanent nerve injury.

Methods: Inclusion criteria included a diagnosis of carpal tunnel syndrome based on a history, physical examination and electrodiagnostic studies, failure of a short trial of conservative therapy or advanced disease as evidenced by sensory, motor or atrophic changes in the median nerve distribution. Exclusion criteria included prior surgery, wrist extension of <40 degrees, mass within the carpal tunnel, Guyon’s syndrome or bony carpal tunnel abnormalities. Patients meetings these criteria were treated by the Brown two-portal endoscopic technique.

Results:A total of 14,722 patients were treated with the Brown endoscopic technique. A total of 11 patients (0.07%) required conversion to an open procedure. There was one iatrogenic injury. Post-operative results were inversely correlated to the severity of pre-operative electrodiagnostic results and the duration of symptoms regardless of the method of non-operative treatment.

Conclusions: Operative decompression should be carried out promptly, if symptoms have been present for ≥ 2 months, as the occurrence of permanent nerve damage has been noted within this time frame. In light of our experience, we advocate the use of the two-portal endoscopic technique as previously described by Brown, et al. for this purpose.

Christopher Hankins, MD, Michael G. Brown, MD, Randolph Lopez, M.D, Andrew Lee, MD, Joseph Dang, MD, and R. Douglas Harper, MD.
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