Background The purpose of this study was to determine the incidence of neurologic hand complications after radial artery harvesting and to compare the harmonic scalpel versus conventional cold scalpel technique. Methods From 1995 to 2000, 786 radial arteries were harvested from 782 patients for coronary artery bypass grafting. From 1995 to 1997, the conventional cold scalpel technique was used (422 patients), and from 1998 to 2000, the harmonic scalpel was used (360 patients). Mean follow-up was 4.2 ± 2.1 years and was 90% complete. Symptoms included thumb weakness or numbness, tingling, or pain in the hand. Results The incidence of neurologic hand complications was similar with both techniques (11.2% ± 3.5% cold, 11.0% ± 3.6% harmonic, p > 0.95), and in 19% (13 of 67 with symptoms) there was complete resolution within 1 year. Symptoms persisted long-term in 9.0% ± 3.2% cold scalpel and 9.0% ± 3.3% harmonic scalpel patients (p > 0.81), but were considered a "constant and significant source of discomfort" in only 0.6% ± 0.9% cold scalpel and 1.4% ± 1.3% harmonic scalpel patients (p > 0.41). Conclusions The incidence of adverse neurologic outcomes causing significant long-term discomfort in the hand was low using either the cold scalpel or harmonic scalpel technique. However, a significant number of patients had neurologic hand symptoms in both groups, and this should be included when discussing operative risks with the patient.