Endoscopic versus Open Carpal Tunnel Release: A Meta-Analysis

Abstract

Introduction: Carpal tunnel syndrome is the most common entrapment neuropathy. This meta-analysis compares endoscopic and open carpal tunnel release for return to function, complications, and symptom relief.

Methods: A meta-analysis of randomized controlled trials was conducted. Inclusion: adult patients with idiopathic carpal tunnel syndrome. Outcomes: time to return to work, grip strength, scar pain, and nerve injury rate. Pooled effect sizes were calculated.

Results: Twenty-two RCTs (n=2,104 patients) were analyzed. Endoscopic release resulted in faster return to work (mean difference 15 days). Scar tenderness was reduced at three months. Grip strength recovery was similar by six months. Nerve injury rate was higher in endoscopic group (0.5% versus 0.1%). Revision rates were comparable (2% each).

Discussion: Endoscopic release offers faster recovery and less scar discomfort, but carries a slightly higher risk of nerve injury. Open release remains simpler and cost-effective. Surgeon experience influences outcomes for both techniques.

Conclusions: Both techniques are effective. Endoscopic release may be preferred for patients requiring rapid return to manual work. Open release remains a safe standard.