Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature.

Carpal Tunnel Syndrome (CTS) has been referred to as the most common peripheral entrapment neuropathy. As Mirza and colleagues note, its incidence continues to increase. Einhorn and Leddy cite Palmer's estimated incidence of 1% in the general population and 5% or more of workers in certain industries which require repetitive use of the hands and wrists. Conservative treatment of CTS includes splinting and modification of activities. However, surgical release of the transverse carpal ligament or the flexor retinaculum is an extremely common procedure. The open surgical technique has been used since 1924 and is still considered by many to be the gold standard. In 1989 Oksuto introduced the endoscopic carpal tunnel release (ECTR) with the rationale of potentially decreasing the prevalence of complications. In the ensuing years, endoscopic results have generated a tremendous amount of study and controversy. Berger reported that many "passionate arguments both for and against the use of ECTR" exist. This paper briefly reviews the literature generated by this debate, focusing on one potential postoperative complication: pillar pain. Various definitions of pillar pain are noted, and suggested etiologies are grouped into four categories. This is followed by a brief discussion of the treatment approaches and issues.