September 10, 2013
Greater Risk of Pain and Dysfunction After Open Carpal Tunnel Release
The article so entitled by Boya et al. published in Muscle and Nerve, November 2008, Volume 38, pages 1443-1446, pointed out the frequent postoperative problems after open carpal tunnel release such as persistent weakness, pillar pain (deep-seated ache or pain over the thenar or hypothenar region or both), and scar tenderness contribute greatly to patient dissatisfaction. In 50 patients in whom they performed open carpal tunnel release and given an average of 20 months of recovery time, 7% still had scar tenderness, 13% had pillar pain, and 18% had burning discomfort. Boya et al. attributed this to the surgical technique in treating the patient. These authors made a strong point in support of endoscopic carpal tunnel release and quoted Polysen et al, Journal of Hand Surgery British, 1997, Volume 22, pages 325-327, as reporting less pillar pain at the end of 3 months following endoscopic carpal tunnel release (ECTR). Younk et al. of Journal of Hand Surgery, 2005, Volume 10, pages 29-35, noted 9% of their patients still had pillar pain at 18 months and Bradley et al. as reported in Hand Surgery, 2003, Volume 8, pages 59-63, found persistent pain in 20% of hands 12 months after open carpal tunnel release. This is probably because the subcutaneous nerves that had been proven in careful dissection are probably injured in open carpal tunnel release but are completely avoided in using properly applied endoscopic technique.
I don’t feel that it is really fair to compare open carpal tunnel release with endoscopic carpal tunnel release because endoscopic carpal tunnel release patients do recover so much quicker and in general have such a good outcome in contrast to open carpal tunnel release patients. It is also important to note that the fear of the morbidity and side-effects from the open carpal tunnel technique tend to make patients procrastinate in getting to surgery until they are more likely to have poor outcomes anyway, thus implicating delay in treatment in some of the poor results. The least discomfort, more aesthetically pleasing, and safer techniques that we can employ are at greater advantages for our patients. It is for this reason that I have been offering endoscopic carpal tunnel release for the past 18-1/2 years with an extremely high satisfaction, low-complication rate.