The aim of this prospective, randomised study is to compare outcomes within three groups of patients undergoing either open, one-portal or two-portal endoscopic carpal tunnel release. The study population consisted of 90 hands in 59 patients presenting with idiopathic carpal tunnel syndrome and symptom duration greater than 6 months, or those patients who had not gained satisfactory symptomatic relief from conservative treatments. Only patients with positive nerve conduction studies were included in the study. All patients were assessed using a standardised protocol which included a questionnaire on activities of daily living and symptoms experienced rated using a visual analogue scale. An examination followed which included; provocative tests; grip, pinch and abduction strengths; light touch; moving two-point discrimination; and vibration testing. Each patient was subsequently randomly allocated to one of the three surgical groups. All patients were assessed postoperatively, using a standa

We found no significant differences between the three surgical groups with regard to postoperative pain, level of satisfaction and objective return of grip and pinch strengths. The ability to perform activities of daily living postoperatively, however, was significantly reduced in the open technique group compared with patients treated with either endoscopic technique. There was also a significant difference in the time taken to return to work in the open group compared with both the endoscopic groups.

No neurovascular complications occurred in our series. The only complications that occurred were in the open group and included; prolonged scar tenderness, severe post-operative bruising of the forearm, and infection.