Abstract
The objective of this study is to do a meta-analysis of the literature and compare the safety and efficacy of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) for idiopathic carpal tunnel syndrome (CTS). A comprehensive literature search of the electronic databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register was undertaken for randomized studies reporting carpal tunnel syndrome treated with ECTR or OCTR. The quality of randomized trials was critically assessed. Pooled relative risk (RR) and 95% confidence intervals (CIs) for safety and efficacy outcome variables were calculated by fixed-effect or random-effect methods with RevMan v.5.1 provided by the Cochrane Collaboration. A total of 13 randomized trials were included by total retrieve and riddling. The results of our meta-analysis showed no significant difference in the overall complication rate (RR = 1.34, 95% CI [0.74, 2.43], P = 0.34), subjective satisfaction (RR = 1.0, 95% CI [0.93, 1.08], P = 0.92), time to return to work (mean difference = −3.52 [−8.15, 1.10], P = 0.14), hand grip and pinch strength, and the operative time (mean difference = −1.89, 95% CI [−5.84, 2.06]) between patients in the ECTR and OCTR groups (P = 0.16, 0.70, and 0.35, respectively). The rate of hand pain (RR = 0.73, 95% CI [0.53, 0.93], P = 0.02) in the ECTR group was significantly lower than that in the OCTR group. ECTR treatment seemed to cause more reversible postoperative nerve injuries as compared with OCTR (RR = 2.38, 95% CI [0.98, 5.77], P = 0.05). Although ECTR significantly reduced postoperative hand pain, it increased the possibility of reversible postoperative nerve injury in patients with idiopathic CTS. No statistical difference in the overall complication rate, subjective satisfaction, the time to return to work, postoperative grip and pinch strength, and operative time was observed between the two groups of patients.
Highlights
Carpal tunnel syndrome (CTS) is one of the most common causes of neuropathy in the upper extremities
Outcome measurement and definition Patient outcome measurement included complications, operative time, postoperative subjective satisfaction in at least 12 weeks after surgery, hand pain rate 12 weeks after surgery, hand grip and pinch strength, and the time to return to work
In a randomized trial by Brown et al [20] who evaluated hand function and time to return to work in 84 endoscopic carpal tunnel release (ECTR) and 85 open carpal tunnel release (OCTR) surgeries involving 151 patients with carpal tunnel syndrome, the median time for patients in the ECTR group to return to work was 14 days versus 28 days in the OCTR group (P = 0.05)
Summary
Carpal tunnel syndrome (CTS) is one of the most common causes of neuropathy in the upper extremities It occurs most often in patients aged 30 to 60 years and is two- to threefold more common in women than in men [1]. In a systematic review and meta-analysis of randomized trails concerning ECTR and OCTR, Thoma et al [12] concluded that there was no significant difference between ECTR and OCTR in terms of symptomatic relief. They found that the results about return to work and hand function were conflicting and that the risk of reversible nerve injury was significantly increased in ECTR patients
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