Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial

EDITOR – Atroshi et al (1) show a small difference in scar pain after
endoscopic carpal tunnel release in comparison to the open technique with
no effect on the patients’ time off-sick. In line with the results of
previous studies (2) they rightly question the cost effectiveness of
endoscopic carpal tunnel surgery.

As a Plastic Surgeon who routinely performs open carpal tunnel
release I would have found it very useful to have known more about the
technique of open carpal tunnel release used in this paper. Especially, no
reference was made to a potential injury to the palmar branch of the
median nerve, which is relevant for post-operative scar tenderness. Most
surgeons would place the skin incision for open carpal tunnel release in
order to avoid this nerve, but a nerve branch often runs across the
incision and is inevitably divided by the standard open technique. A
“paper that changed my practice” demonstrated that careful preservation of
this branch results in significantly less scar discomfort after open
carpal tunnel release (3). There may well be no difference at all in scar
pain between open and endoscopic carpal tunnel release.

1 Atroshi I, Larsson G-U, Ornstein E, Hofer M, Johnsson R, Ranstam J.
Outcomes of endoscopic surgery compared with open surgery for carpal
tunnel syndrome among employed patients: randomised controlled trial. BMJ
2006;332:1473-6

2 Thoma A, Veltri K, Haines T, Duku E. A meta-analysis of randomized
controlled trials comparing endoscopic and open carpal tunnel
decompression. Plast Reconstr Surg 2004;114:1137-46

3 Ahcan U, Arnez ZM, Bajrovic F, Zorman P. Surgical technique to
reduce scar discomfort after carpal tunnel surgery. J Hand Surg
2002;27[Am]:821-7

Competing interests:
None declared