Abstract
Purpose In many procedures, both high case volumes and fellowship training have been shown
to improve outcomes. One of the most common procedures performed by hand surgeons,
the carpal tunnel release (CTR) is also performed by several other specialties without
specialty training in a hand fellowship. This study analyzed the effect that hand
fellowship training has on outcomes of CTRs.
Materials and Methods Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates’ case list
submissions, a database was created for all open and endoscopic CTRs. Surgeon training,
demographics, technique, and complications were recorded. Complications were then
categorized and broken down by technique. Results were then analyzed for statistical
significance.
Results A total of 29,916 cases were identified. Hand fellowship–trained surgeons performed
six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship–trained
surgeons. They also improved outcomes in rates of infection, wound dehiscence, and
overall complications. Rates of nerve injury or recurrence showed no statistical difference.
This held true for the open release subset. Endoscopically, fellowship-trained surgeons
had only improved rates of overall complications.
Conclusion Surgeons undergoing additional hand fellowship training may show improved outcomes
in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on
nerve injury or recurrence of symptoms.
Keywords
hand fellowship - carpal tunnel release - median nerve
