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Incidence of Transient Median Nerve Neuropraxia Following Endoscopic Carpal Tunnel Release

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ABSTRACT

The risks and benefits of endoscopic carpal tunnel release remain controversial. Advocates view this technique as a minimally invasive procedure allowing more rapid return to work and activities; however, others view endoscopic carpal tunnel release as a potentially dangerous procedure with an unfavorable risk/benefits ratio. Both positions are supported by the literature.

The reported incidents of transient neuropraxia of the median nerve following endoscopic carpal tunnel release is low in several studies and nonexistent in most studies. The authors have noted a higher incidence of transient neuropraxia than is currently reported. This study evaluated a series of double portal endoscopic carpal tunnel releases to determine the incidence of transient neuropraxia of the median nerve.

A retrospective chart review was undertaken to determine the incidence of transient neuropraxia of the median nerve following double portal endoscopic carpal tunnel release. A total of 378 patients were identified by our office patient computer base. The cases were consecutive and all procedures were performed in our local hospitals and surgery centers. Standard published techniques for endoscopic carpal tunnel release were used in all cases. Charts were retrospectively reviewed to assess the documented incidents of postoperative neuropraxia based on subjective complaints of the patient and objective findings. Nine patients had postoperative neuropraxia of the median nerve. This yielded an overall incidence of 2.4%. All but one resolved spontaneously within a 2-month period. The final patient is still being followed.

The authors believe the introduction of the cannula into the carpal tunnel causes trauma to the median nerve, occasionally resulting in transient neuropraxia. The authors also believe that although the incidence in this report is 2.4% based on the retrospective review, it would likely be much higher if evaluated in a prospective study with more critical analysis during the early postoperative period. Although mild degrees of subjective neuropraxia during the early postoperative period have no substantial effect on the ultimate outcome, it is nevertheless concerning to the patient and should be discussed preoperatively.