The value of one-portal endoscopic carpal tunnel release: a prospective randomized study.

A randomized prospective study was carried out to compare one-portal endoscopic carpal tunnel release with an open procedure. There were 47 patients (mean age 52.6 years); 25 underwent an endoscopic and 22 an open release. The aim of the study was to evaluate the risks against the benefits for pain, grip, key-pinch strength and ability to return to work. The distribution of age, occupation, sex, neurographic findings and operated hand was similar in both groups. We detected no serious nerve complications. One "open" patient developed a hypertrophic scar, a second "open" patient a disabling reflex sympathetic dystrophy, one "endo" patient a transient neurapraxia. The remaining patients experienced complete relief of symptoms. Improvement of grip strength is significantly better after endoscopic release (P = 0.0001 at 3 months). In contrast, the key-pinch showed a similar pattern of improvement in both groups. The ability to use the operated hand as effectively as the contralateral one developed after 24 days for the endoscopic group versus 42 for the open approach (P = 0.0000). The carpal arch alteration was less important for the endoscopic group (P = 0.013), but without any correlation with the grip strength. Agee's one-portal technique only allows correct placement of a knife, not an inspection of the structures being operated upon. This is a major limitation, reducing the surgeon to a technician. Further development of this procedure demands a device that will enable a fruitful inspection of the carpal tunnel.