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Comparative Effectiveness Review of Endoscopic Surgery for Carpal Tunnel Release: A Review of Reviews

November 30, 2018

Health Problem: Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. It is characterized by increased pressure within the carpal tunnel and decreased function of the nerve. The estimated prevalence of CTS is 3.1% to 7.8% among adult workers, with higher prevalence among female and older-age workers.

Technology Description: Surgery for CTS is referred to as carpal tunnel release, which involves decompression of the carpal tunnel by cutting through the ligament pressing down on the carpal tunnel. The primary approaches to carpal tunnel release are conventional open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR). OCTR uses a 3- to 4-centimeter (cm) incision that allows the surgeon to view the inside of the hand and wrist. Mini-OCTR surgery uses a smaller incision, approximately 2 cm in length. ECTR involves either 1 or 2 small 1 to 2 cm skin incisions (i.e., the single-portal or double-portal technique).

Controversy: OCTR is the current standard for surgical treatment for CTS. Endoscopic techniques have been suggested to reduce postoperative pain and return to work, as well as to allow for faster recovery of function. However, endoscopy has been criticized due to its learning curve, expensive equipment, and the potential risk of injury to neurovascular structures.

Key Questions:

  • Does ECTR improve clinical outcomes of CTS compared with OCTR or mini-OCTR?
  • What complications are associated with ECTR?
  • Have definitive patient selection criteria been established?