Comparative efficacy and safety of endoscopic, open, and mini-open techniques for carpal tunnel release: A meta-analysis.

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. In addition to traditional open carpal tunnel release (OCTR), endoscopic (ECTR) and mini-open (MOCTR) approaches have been developed as minimally invasive alternatives. However, comparative evidence regarding their clinical efficacy and safety remains inconsistent.

METHODS

A systematic review and meta-analysis were performed according to PRISMA guidelines, including 44 comparative studies (38 comparing ECTR vs OCTR and 6 comparing ECTR vs MOCTR) involving adult patients with idiopathic CTS. Outcomes extracted included pain (VAS), functional scores (BCTQ-SSS, BCTQ-FSS, DASH), grip and pinch strength, sensory symptoms, and complications such as pillar pain, nerve injury, opioid use, and revision CTR.

RESULTS

Across all functional measures (DASH, BCTQ-FSS, BCTQ-SSS), pain, and sensory outcomes, pooled analyses demonstrated no statistically significant differences between ECTR, OCTR, and MOCTR. Grip and pinch strength were also comparable, indicating equivalent long-term motor recovery. Postoperative VAS pain scores did not differ significantly between ECTR and OCTR (p = 0.10). Nerve injury also showed no significant difference between techniques in the random-effects model (p = 0.56). Opioid prescription rates were similar across groups. Notably, ECTR demonstrated a significantly lower revision CTR rate compared with OCTR (risk ratio = 0.46, 95 % CI 0.29-0.73; p = 0.0009).

CONCLUSION

Open, mini-open, and endoscopic carpal tunnel release techniques provide comparable outcomes in pain relief, functional recovery, strength, sensory symptoms, and overall safety for idiopathic CTS. Although revision CTR occurred less frequently after ECTR in the pooled analysis, the clinical significance of this difference remains uncertain. Technique selection should therefore be individualized based on surgeon expertise, patient priorities, and resource availability.