Additional modifications in technique for a smaller or limited incision have been accompanied by many variations of knives, rasps and tubes through which these instruments and the imaging arthroscope or endoscope are passed.
Athrex, Brown-Instratek, Linvatek and other manufacturers modified the original one or two portal systems for endoscopic carpal tunnel release.
One prospective, randomized, multi-center study found no significant differences between the two groups with regard to the secondary quantitative outcome measurements.
A prospective randomized study using the MicroAire system was conducted in 2002 by Trumble and Diao et al. and revealed that good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used.
However, the open technique resulted in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work.
[6] It has been shown in recent literature that there is a learning curve for a hand surgeon who begins to use an endoscopic technique to release the transverse carpal ligament.
Brown et al. conducted a prospective, randomized, multi-center study and found no significant differences between the two groups with regard to secondary quantitative outcome measurements.
A prospective randomized study done in 2002 by Trumble revealed that good clinical outcomes and patient satisfaction are achieved more quickly with the endoscopic method.
However, the open technique caused greater scar tenderness during the first three months after surgery, and a longer time before the patients could return to work.
At the 2007 meeting of the American Society for Surgery of the Hand, a former advocate of endoscopic carpal tunnel release, Thomas J. Fischer, MD, retracted his advocacy of the technique, based on his own personal assessment that the benefit of the procedure (slightly faster recovery) did not outweigh the risk of injury to the median nerve.
[12] A meta-analysis supports the conclusion that endoscopic carpal tunnel release is favored over the open carpal tunnel release in terms of a reduction in scar tenderness and increase in grip and pinch strength at a 12-week follow-up[13][14] A study comparing the open method and endoscopic method resulted in a longer interval until the patient could return to work (median, twenty-eight days, compared with fourteen days for the open-release and endoscopic-release groups).