Very Early Outcomes in Endoscopic Versus Open Carpal Tunnel Release

Purpose Although many studies have focused on long-term postoperative outcomes for endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR), few have focused on results in the very early postoperative period of days 3–14. This period is particularly important in some cases as a patient's ability to function well with little pain early after surgery can be critical in regaining function, meeting family responsibilities, and returning to work. We hypothesized that ECTR patients would have improved function and less pain within the very early time postoperative period and return to work earlier compared to OCTR patients. Methods A prospective, multicenter study was performed over 2 years. Three fellowship-trained hand surgeons participated. Postoperative care and activity instructions were standardized for all three participating surgeons for both OCTR and ECTR. Results Patients undergoing carpal tunnel release via both OCTR and ECTR experienced progressive improvement in pain and function with the surgically treated hand, with significantly better outcomes seen in the endoscopic cohort. Decreased pain based on the Numeric Rating Scale and the Patient-Rated Wrist and Hand Evaluation Pain scale were found at postoperative day (POD) 3, 7, and 14 for the ECTR group compared to the OCTR group. Higher Single Assessment Numeric Evaluation and better Patient-Rated Wrist and Hand Evaluation function scores indicating earlier return of function were seen after endoscopic release. Finally, there was a significant difference ( P < .5) in the number of patients who returned to work on POD 3 and POD 7 favoring the ECTR approach. Conclusions ECTR is associated with benefits in pain and function in the very early postoperative period favoring endoscopic intervention at PODs 3, 7, and 14, with earlier rates of return to work on PODs 3 and 7 in favor of the endoscopic group. Type of study/level of evidence Therapeutic IIc.