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Improved Surgical Outcomes with Endoscopic Carpal Tunnel Release in Patients with Severe Median Neuropathy
Nicholas A. Calotta, BA; Joseph Lopez, MD, MBA; E. Gene Deune, MD, MBA
Johns Hopkins University School of Medicine, Baltimore, MD

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. CTS symptoms range from mild to severe, and are managed by either endoscopic (ECTR) or open (OCTR) carpal tunnel release. Currently, severe CTS is more commonly treated with OCTR. However, little is known regarding the efficacy and safety of ECTR for severe CTS. In this study, we evaluated the role of ECTR in severe CTS.
Methods: This is a retrospective cohort study of patients with severe CTS who underwent either ECTR or OCTR. We defined severe CTS with electrodiagnostic parameters: complete block of median nerve sensory response and motor response < 4mV with latency > 6.45ms. The primary outcome variable was patient reported complete resolution of pre-operative CTS symptoms at last recorded follow-up. Secondary variables included rate of complications and recurrence/reoperations. Outcome variables were assessed by a ‘blinded’ reviewer who had no knowledge of pre-operative diagnostic information.
Results: We identified 138 cases of severe CTS. 28.3% (n = 39) were treated with ECTR and 71.7% (n = 99) with OCTR. The cohorts were similar in terms of demographics and comorbidities. Patients treated with ECTR had complete resolution of CTS symptoms in 81.6% of cases while those treated with OCTR had complete resolution in 39.0% (p < 0.001). In the ECTR cohort, complications (n = 0; 0%) and recurrence (n = 2; 2.6%) were both rare. In the OCTR cohort, complications (n = 2; 2.0%) and recurrence (n = 10; 10.1%) were more common. Reoperation was required in 4.0% (n = 4) of OCTR cases and 0% (n = 0) of ECTR cases.
Conclusions: ECTR is a safe treatment option for patients with severe CTS. Moreover, our data indicates that ECTR is at least as effective as OCTR in remediating pre-operative CTS symptoms in patients with severe CTS. Although further, high level-of-evidence studies are needed, surgeons should consider ECTR when discussing treatment options for severe CTS.

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