Midline mini-ıncision versus a modified open technique in open carpal tunnel release: A retrospective comparative cohort study

Aim: To compare the standard midline mini-incision with a modified open technique preserving superficial nerve branches in primary open carpal tunnel release (OCTR).

Materials and Methods: This retrospective cohort study included consecutive patients undergoing primary OCTR at one tertiary center between January 2021 and June 2024. Patients were grouped by technique: midline mini-incision (Group A, n = 36) or modified open technique (Group B, n = 32). The modified technique uses a curvilinear incision along the ulnar border of the thenar crease, layered dissection to identify and preserve superficial nerve branches, and a fascial flap covering the released canal. The primary outcome was pillar pain at 3 months. Secondary outcomes included Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores, time to return to daily activities, wound complications, scar tenderness, grip strength recovery, and revision rates.

Results: Sixty-eight wrists in 62 patients were analyzed. Baseline characteristics and preoperative scores were comparable. Pillar pain at 3 months was lower in Group B (9.4% vs 33.3%; adjusted OR 0.21, 95% CI 0.05 – 0.84; p = 0.027). Both groups improved significantly in BCTQ-SSS and BCTQ-FSS. Postoperative BCTQ-SSS was lower in Group B (1.42 ± 0.38 vs 1.68 ± 0.51; p = 0.018), whereas BCTQ-FSS did not differ (1.34 ± 0.32 vs 1.45 ± 0.41; p = 0.216). Return to daily activities was faster in Group B (17.8 ± 5.9 vs 24.2 ± 7.5 days; p < 0.001), while operative time was shorter in Group A (8.4 ± 2.3 vs 15.1 ± 3.2 minutes; p < 0.001). Complication rates were comparable.

Conclusion: Both techniques provide safe and effective median nerve decompression. The modified technique was associated with less pillar pain, lower postoperative symptom severity, a trend toward reduced scar tenderness, and faster return to daily activities, whereas the midline mini-incision offers shorter operative time.