Abstract
BackgroundThe Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather “blind” procedure and on the high number of severe complications that have been reported in the literature.PurposeTo evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release.MethodsWe searched MEDLINE (January 1966 to November 2013), EMBASE (January 1980 to November 2013), the Cochrane Neuromuscular Disease Group Specialized Register (November 2013) and CENTRAL (2013, issue 11 in The Cochrane Library). We hand-searched reference lists of included studies. We included all randomized or quasi-randomized controlled trials (e.g. study using alternation, date of birth, or case record number) that compare any ECTR with any OCTR technique. Safety was assessed by the incidence of major, minor and total number of complications, recurrences, and re-operations.The total time needed before return to work or to return to daily activities was also assessed. We synthesized data using a random-effects meta-analysis in STATA. We conducted a sensitivity analysis for rare events using binomial likelihood. We judged the conclusiveness of meta-analysis calculating the conditional power of meta-analysis.ConclusionsECTR is associated with less time off work or with daily activities. The assessment of major complications, reoperations and recurrence of symptoms does not favor either of the interventions. There is an uncertain advantage of ECTR with respect to total minor complications (more transient paresthesia but fewer skin-related complications). Future studies are unlikely to alter these findings because of the rarity of the outcome. The effect of a learning curve might be responsible for reduced recurrences and reoperations with ECTR in studies that are more recent, although formal statistical analysis failed to provide evidence for such an association. Level of evidence: I.
Highlights
Carpal tunnel syndrome (CTS) is the most common compression neuropathy
Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is associated with less time off work or with daily activities
There is an uncertain advantage of ECTR with respect to total minor complications
Summary
Surgical treatment for CTS involves cutting the transverse carpal tunnel ligament (TCL) to release pressure on the median nerve. Several studies in the 1990s demonstrated an unacceptably high risk of complications, adding to skepticism about the new treatment [3,4,5,6]. The main argument supporting this criticism is that the surgeon is partially ‘blind’ during ECTR This entails two main risks, these being failure to identify the distal edge of the TCL, resulting in incomplete release with subsequent recurrence and reoperation and damage to other structures, to anatomical variants of the median nerve and branches [5,6,9]. More recent studies have described an equal complication rate with ECTR and conventional OCTR, controversy remains [10,11]. To evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
