This 1993 prospective randomized multicenter trial compared standard open versus two-portal endoscopic carpal tunnel release in 169 hands of 145 patients with electrodiagnostically confirmed carpal tunnel syndrome. All patients had failed conservative management. Follow-up was performed at 21, 42, and 84 days by a blinded observer.
When counseling a patient on technique choice for carpal tunnel release, both approaches eliminate symptoms at equivalent rates — the decision hinges on recovery expectations and risk tolerance. Endoscopic release cuts return-to-work time in half (14 vs. 28 days) and reduces scar tenderness, making it attractive for working-age patients in time-sensitive occupations.
The tradeoff is real: every intraoperative complication in this trial occurred in the endoscopic group, including a digital nerve contusion that impaired a surgeon for three months and a training-period nerve transection that caused reflex sympathetic dystrophy requiring stellate ganglion blocks.
This paper established that endoscopic release is not a casual upgrade from open. It demands cadaveric training, structured mentorship, and explicit intraoperative identification of the superficial palmar arch and digital nerves before the endoscope is advanced.
For patients with recurrent carpal tunnel syndrome, inflammatory arthropathy, peripheral neuropathy, or pregnancy, neither technique was studied here. These were explicit exclusion criteria and remain indications for individualized planning.
This 1993 prospective randomized multicenter trial compared standard open versus two-portal endoscopic carpal tunnel release in 169 hands of 145 patients with electrodiagnostically confirmed carpal tunnel syndrome. All patients had failed conservative management. Follow-up was performed at 21, 42, and 84 days by a blinded observer.
When counseling a patient on technique choice for carpal tunnel release, both approaches eliminate symptoms at equivalent rates — the decision hinges on recovery expectations and risk tolerance. Endoscopic release cuts return-to-work time in half (14 vs. 28 days) and reduces scar tenderness, making it attractive for working-age patients in time-sensitive occupations.
The tradeoff is real: every intraoperative complication in this trial occurred in the endoscopic group, including a digital nerve contusion that impaired a surgeon for three months and a training-period nerve transection that caused reflex sympathetic dystrophy requiring stellate ganglion blocks.
This paper established that endoscopic release is not a casual upgrade from open. It demands cadaveric training, structured mentorship, and explicit intraoperative identification of the superficial palmar arch and digital nerves before the endoscope is advanced.
For patients with recurrent carpal tunnel syndrome, inflammatory arthropathy, peripheral neuropathy, or pregnancy, neither technique was studied here. These were explicit exclusion criteria and remain indications for individualized planning.