Endoscopic compared with open carpal tunnel release.

Abstract

To The Editor: In Single-Portal Endoscopic Carpal Tunnel Release Compared with Open Release. A Prospective, Randomized Trial (2002;84:1107-15), Trumble et al. used questionnaires, standardized functional tests, and physical measurements to compare the results of single-portal endoscopic carpal tunnel release with those of open carpal tunnel release. The results of the studies were subjected to statistical analysis. We have several comments and questions. Differences that are statistically significant are not necessarily clinically significant. Do the authors believe that the statistically significant differences between the endoscopic group and the open-release group are clinically significant? For example, do the authors believe that the statistically significant difference in the results of the Purdue pegboard test at four weeks is clinically significant? The authors reported that patients who underwent endoscopic carpal tunnel release returned to work sooner than those who underwent open carpal tunnel release. Return to work is an inexact measure of success. Louis l pointed out that objective, definable, measurable endpoint has been used to assess appropriateness for return-to-work status. The decision to return to work is largely physician-driven, and may be biased by patient motivation... Other authors have reported no significant difference in the time to return to work between patients who underwent endoscopic carpal tunnel release and those who underwent open carpal tunnel release 2-4. How did Trumble et al. decide when to advise a patient to return to work? What did Trumble et al. tell their patients about the nature of the study, and might this in any way have influenced return to work? Also, in the first paragraph of their study, Trumble et al. referenced a paper by Adams et al. in which only 67% of patients with occupational carpal tunnel syndrome were able to return to their original job 5. The poor rate …