Risk and Complications in Endoscopic Carpal Tunnel Release

Abstract

Single portal endoscopic carpal tunnel release was carried out in 107 hands of 88 patients. There were 11 complications. These included incomplete release (2), post operative scarring around the median and ulnar nerves (2), laceration of the superficial palmar arterial arch (1), reflex sympathetic dystrophy (2), palmar fasciitis (1), and wound inflammation (3). In two cases there was no relief of symptoms. In one there was incorrect diagnosis and in another, incorrect indication for endoscopic carpal tunnel release. The follow-up was from 3 to 18 months with an average of 6.8 months. The overall results of the patients in this series are being presented in another paper. Of the 107 procedures, 73 were rated as having an excellent, 25 good, three fair, and six poor results. The case of laceration of the superficial palmar arterial arch is discussed in detail in the paper. The two cases of reflex sympathetic dystrophy and the one case of palmar fasciitis had mild clinical features and resolved within 3 months. The inflammation in three of the wounds at the wrist resolved within 2 days of removal of the percutaneous sutures. These three patients had returned to heavy hand activities within a few days of surgery.

Incidence of Complex Regional Pain Syndrome Following the Carpal Tunnel Release Surgery

“…We found an incidence of 6.6% for CRPS following the CTR surgery, which was comparable to the results of previous reports (6).…”

“…Da Costa et al reported an incidence of 8.3 % for CRPS following the CTR surgery (15), which was higher than the incidences reported earlier (2.1% to 5%) (6). We found an incidence of 6.6% for CRPS following the CTR surgery, which was comparable to the results of previous reports (6).…”

“…The literature reports an incidence of 2.1% to 5% for CRPS after CTR surgery (6,7). However, several other factors such as motor nerve injury, ethnic factors, and gender have been reported to affect this incidence (3,8).…”

The operative treatment of carpal tunnel syndrome and its relevance to endoscopic release

“…These complications range from simple incomplete release of the transverse carpal ligament to injuries to the superficial palmar arterial arch, from transection of the ulnar artery to persistent sensory disturbances of individual digital nerves, severe scarring around the median and ulnar nerves, partial injuries to and complete transections of either nerve [2,8,12,13,14,17,18].…”

Carpal tunnel pressure in patients with carpal tunnel syndrome due to long-term hemodialysis

“…By measuring the pressure throughout the carpal tunnel during the ECTR, sufficient decompression can be achieved and incomplete release avoided [2,17]. We can also prevent excessive release leading to neurovascular injury [20]. In this study, we performed ECTR with simultaneous measurement of the carpal tunnel pressure using the original method in HD-CTS and in I-CTS.…”