Correspondence (reply): In Reply

Painful scarring after splitting the retinaculum constitutes a certain problem, but this is as a rule of a temporary nature. As tour correspondents rightly point out, this is usually due to the severing of small, sensitive nerve branches from the palmar branch of the median nerve with or without a connection to the sensitive branches of the ulnar nerve (and presumably also the cause of the so called pillar pain). As the course of nerve branches can vary, no method—not even endoscopic surgery—guarantees that they will be spared, all that can be done is minimizing the risk. By comparison, the double-incision method explained by our correspondents is (much like endoscopic approaches) technically more demanding than open incision with a slightly longer incision. They rightly mentioned the required learning curve, which is also true for endoscopic interventions. The suggested open method using two incisions is probably superior to the often used mini-incisions, as it allows reliable splitting of the proximal parts of the retinaculum under conditions of good visibility, and simultaneously it minimizes the risk of nerve injury.

The discussion around the best and, importantly, the safest surgical method in carpal tunnel syndrome is ongoing: a recently published meta-analysis (1) explicitly mentions the learning curve and the surgeon’s individual experience, which will have to be given more attention in future studies. One thing is certain, however, and holds true for most surgical procedures: the more experienced the surgeon (this is also the case for defining the indication), and the more familiar s/he is with the relevant method, the lower the risk of complications and the better his/her outcomes (2).

It is worth mentioning that carpal tunnel syndrome became notifiable in Germany as an occupational disorder on 1 January 2015.