What You See is What You Get: Improved Patient Outcomes with Anterograde Endoscopic versus Open Carpal Tunnel Release

Introduction: Carpal tunnel syndrome, a common neuropathy caused by median nerve compression, impairs hand function and quality of life. While retrograde endoscopic carpal tunnel release (CTR) comparisons with open CTR has been extensively studied, limited research has been conducted on anterograde endoscopic CTR, which provides proximal-to-distal visualization of the transverse carpal ligament. This study aimed to compare Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Upper Extremity (UE) scores between open and anterograde endoscopic CTR over one year. Methods: Patients were identified through a retrospective chart review of surgery schedules for hand and wrist surgeons affiliated with a large academic institution. Demographic data, surgical approach, and pertinent history were extracted through review of patient medical records. Pre-operative and post-operative PROMIS Pain Interference (PI) and Upper Extremity (UE) scores were collected, and a multivariate analysis was completed to screen factors predictive of improved PROMIS scores. Results: Patient BMI, sex, history of traumatic wrist injury, cervical disease, symptom duration, and form of procedure received (open versus endoscopic) were all significantly predictive of PROMIS scores following CTR (R2 = 0.41). Open CTR was also independently associated with reduced PROMIS UE and increased PROMIS PI scores following surgery. Conclusions: Assessing CTRs performed by hand surgeons at a single institution (HFHS), anterograde endoscopic CTR resulted in improved PROMIS outcomes compared to open CTR, demonstrating its efficacy in patient-reported recovery. Further research should aim to confirm these findings among a larger, more diverse patient population.