Endoscopic Carpal Tunnel Release Group Research Articles

Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision-

BackgroundThe purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy.MethodsSixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient’s satisfaction with the surgery.ResultsIn the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7).ConclusionsECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.

Comparison of open and endoscopic carpal tunnel surgery regarding clinical outcomes, complication and return to daily life: A prospective comparative study.

Objective:This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques.Methods:This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared.Results:The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05).Conclusion:ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length.

Prospective, randomized evaluation of endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: an interim analysis.

Most randomized trials have shown similar results with endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR); however, there are studies suggesting less postoperative pain, faster improvement in grip and pinch strength, and earlier return to work with the endoscopic technique. The goal of this study was to prospectively examine subjective and functional outcomes, satisfaction, and complications after both ECTR and OCTR in the opposite hands of the same patient, serving as their own control. This was a prospective, randomized study in which patients underwent surgery for bilateral carpal tunnel syndrome. The first carpal tunnel release was performed on the most symptomatic hand-determined by the patient. Operative approach was randomly assigned and, approximately 1 month later, the alternative technique was performed on the contralateral side. Demographic data were obtained, and functional outcomes were recorded preoperatively and postoperatively, including pain score, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength, and overall grip strength. The carpal tunnel syndrome-functional status score and carpal tunnel syndrome-symptom severity score were recorded before surgery and at 2, 4, 8, 12, and 24 weeks postoperatively. Overall satisfaction with each technique was recorded at the conclusion of the study. Currently, 25 subjects have completed final visit testing. There were no differences in pain score, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength, or overall grip strength at any of the postoperative time points. Carpal tunnel syndrome-symptom severity score and carpal tunnel syndrome-functional status score were not significantly different between groups at any of the evaluations. Overall satisfaction, where patients recorded a number from 0 to 100, was significantly greater in the ECTR group (95.95 vs 91.60, P = 0.04). There were no complications with either technique. This interim analysis, using the same patient as an internal control, suggests that both OCTR and ECTR are well tolerated with no differences in functional outcomes, symptom severity and functional status questionnaires, or complications. Although there were no differences between groups using our study metrics, patients still preferred the ECTR, demonstrated by significantly higher overall satisfaction scores at the conclusion of the study.

Comparison of morphologic consequences of open and endoscopic carpal tunnel release

ObjectivesThe objective of this study is to evaluate the carpal canal morphologic consequences following endoscopic carpal tunnel release compared with open approach. Methods48 Patients with CTS were enrolled in our prospective trial. Participants were classified in 2 groups: 24 patients underwent open surgery technique and 24 underwent endoscopic carpal tunnel decompression. Carpal canal shape and volume, configuration and position of contents, were analyzed by using imaging techniques. ResultsPreoperative carpal canal volume in endoscopic patient group averaged 5.7±1.4 cc and 7.3±2.9 cc at 6 weeks postoperatively (28%±7%, p=0.018). In contrast preoperative carpal canal volume in open carpal tunnel release group averaged 4.9±1.1 cc (and increased to 6.2±1.7 cc at 6-week follow up investigation (36%±5%, p=0.002).Preoperative carpal arch width calculation in endoscopic carpal tunnel release group averaged 21.7±1.1mm and 21.5±1.9mm in open carpal tunnel release patients (p=0.6575). Postoperative carpal arch width measurements in endoscopic carpal tunnel decompression group averaged 22.6±4.1mm and 22.1±2.9mm in open carpal tunnel release patient population at 6-week follow-up investigation (p=0.628). ConclusionEndoscopic approach causes an increment in carpal canal volume comparable to open technique and provides equivalent anatomic outcomes and will produce at least equivalent long-term clinical relief.

Comparison of the electrophysiologic results after two different surgical decompressions of carpal tunnel syndrome

Objective To investigate the extent of electmphysiologic improvement of the two procedures of median nerve decompression after comparing the mid-to long-term electrophysiologic results of endoscopic and open carpal tunnel release of patients with intermediate to severe carpal tunnel syndrome.Methods The clinical data of 46 cases (59 wrists) of carpal tunnel syndrome (CTS) were treated in two groups according to the randomized operation mode,endoscopic carpal tunnel release (ECTR) group (32 wrists in 24 cases) and open carpal tunnel release (OCTR) group (27 wrists in 22 cases).Nerve conduction study was carried out to record compound muscle action potential (CMAP),sensory nerve action potential (SNAP) and sensory nerve conduction velocity (SNCV) one year after the carpal tunnel release.CMAP latency,SNAP amplitude and SNCV were analyzed and compared between the two groups.Results The differences in abductor policis brevis CMAP latency and SNCV one year postoperatively were of statistical significance between the ECTR group and the OCTR group.However,there were no statistically significant differences between the SNAP amplitudes of the two groups.Conclusion The mid-to long-term neuroelectrophysiologic results indicated that the improvement of electrophysiologic indices of conventional OCTR is better than those of the ECTR in treating intermediate to severe carpal tunnel syndrome. Key words: Carpal tunnel syndrome; Endoscopes; Electromyography

SHORT-TERM RESULTS OF ENDOSCOPIC (OKUTSU METHOD) VERSUS PALMAR INCISION OPEN CARPAL TUNNEL RELEASE: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

The surgical techniques widely used in Japan for idiopathic carpal tunnel syndrome (CTS) are the Okutsu method of endoscopic carpal tunnel release (ECTR) and palmar incision for open carpal tunnel release (OCTR). However, no prospective randomized controlled trials (RCTs) have compared treatment outcomes between these two procedures. This RCT compared short-term outcomes between ECTR and OCTR for CTS. Subjects were 101 hands (79 patients) treated in the department. ECTR was performed on 51 hands (40 patients), and OCTR was performed on 50 hands (39 patients). For assessment items, the following patient-based outcomes were evaluated: 1) changes in subjective symptoms; and 2) impairment in activities of daily living. The following items were also evaluated by physicians: 3) abductor pollicis brevis-distal latency (APB-DL); 4) sensation; and 5) muscle strength. All these assessments were made in postoperative weeks 4 and 12. Recovery of muscle strength at postoperative week 4 was significantly better with ECTR (p< 0.05), but no significant differences were identified between groups in any of the other items. The ECTR group showed transient postoperative exacerbation of subjective symptoms in two hands (4%) and of APB-DL in three hands (6%). Comparison of hands with improved and exacerbated postoperative APB-DL in the ECTR group revealed significantly greater preoperative electrophysiological severity in exacerbated hands (p< 0.05). The cause of postoperative exacerbation with ECTR was considered to be transient nerve dysfunction resulting from the unique aspects of the ECTR procedure. Compared with OCTR, ECTR offers superior recovery of muscle strength in the early postoperative period. At the same time, ECTR may carry a risk of transient nerve dysfunction in the early postoperative period. Caution must therefore be exercised when using ECTR for patients with severe electrophysiological findings.

Endoscopic versus open carpal tunnel release: A short-term comparative study

Objective:To compare the results of endoscopic carpal tunnel release (CTR) with open CTR in patients with idiopathic Carpal tunnel syndrome (CTS).Materials and Methods:Seventy-one patients with CTS were enrolled in a prospective randomized study from May 2003 to December 2005. All patients had clinical signs or symptoms and electro-diagnostic findings consistent with carpal tunnel syndrome and had not responded to nonoperative management. Sixty-one cases were available for follow-up. Endoscopic CTR was performed in 30 CTS patients and open CTR was performed in 31 wrists (30 patients). Various parameters were evaluated, including each patient's symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery. All the patients were followed up for six months.Results:During the initial months after surgery, the patients treated with the endoscopic method were better symptomatically and functionally. Local wound problems in terms of scarring or scar tenderness were significantly more pronounced in patients undergoing open CTR compared to patients undergoing endoscopic CTR. Average delay to return to normal activity was appreciably less in group undergoing endoscopic CTR. No significant difference was observed between the endoscopic CTR group and open CTR group in regard to symptom amelioration, electromyographic testing and complications at the end of six months.Conclusion:Short-term results were better with the endoscopic method as there was no scar tenderness. Results at six months were comparable in both groups.

A Cost-Utility Analysis of Open and Endoscopic Carpal Tunnel Release

Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced. To use a decision analytical model to compare ECTR with OCTR in an economic evaluation. Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature. The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the 'win-win' quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR. There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively.

Comparison of Clinical Results of Minimal Incision Versus Endoscopic Carpal Tunnel Release

Purpose : The purpose of our study was to compare the clinical results of minimal incision carpal tunnel release with those of endoscopic release. Materials and Methods : We analyzed 27 patients (41 cases) who had been treated by minimal incision carpal tunnel release and 20 patients (29 cases) treated by single portal endoscopic carpal tunnel release. The average follow up period was 35.2 months. Results were compared between the two groups by assessing subjective satisfaction, postoperative symptoms, grip and pinch strength, two point discrimination and time to recovery. Results : According to Cseuz's criteria, the results were excellent or good in 38 cases (93%) in minimal incision carpal tunnel release group, and in 27 cases (93%) in the endoscopic carpal tunnel release group. Subjective symptoms, grip power, pinch strength, thenar muscle atrophy, two point discrimination test and recovery time were similar in the two groups. Conclusion : We suggest that minimal incision carpal tunnel release and endoscopic carpal tunnel release are equally efficient methods for the treatment of carpal tunnel syndrome.