Comparison of clinical outcomes between open and modified endoscopic release for carpal tunnel syndrome

Abstract

The aim of the present study was to investigate a novel technology, requiring only a single portal and no special equipment, to perform endoscopic treatment of carpal tunnel (CT) syndrome (CTS). This novel technique involves a surgical approach and standard operating procedures and is designed to minimize the potential for complications. Patients with CTS were randomly assigned using a computer-generated random allocation and stratified by site to either the modified endoscopic CT release (MECTR) group ( n=48) or open CT release (OCTR) group (n=46). Various medical indexes were compared between the two groups, including operative time, hospitalization time, the time required to resume a normal life or work, intraoperative complications, incision infection rate, the amelioration of symptoms (Kelly grading), post-operative scar pain score, recovery of grip strength and pinch strength, two-point discrimination and the presence of sympathetic dystrophy. The results revealed that all patients had grade A wound healing and the symptoms were completely relieved. No significant differences were observed between the two groups with regards to the incision infection rate, intra operative complications, grip strength, pinch strength, two-point discrimination, presence of sympathetic dystrophy and clinical symptom amelioration. In addition, compared with the OCTR group, the MECTR group had a decreased operative and hospitalization time, post-operative scar pain score and time required to resume a normal lifestyle. Post-operative electromyographic examination also revealed that the median nerve sensory conduction speed increased compared with that prior to surgery in both groups. In conclusion, the use of MECTR for the treatment of CTS achieved higher patient satisfaction, a shorter operative time and hospitalization time, an earlier return to work time or resumption of a normal life, as well as less post-operative scar pain compared with OCTR. Thus, these results suggested that MECTR may be an effective method for the treatment of idiopathic CTS. Trial registration no. ChiCTR2000041165, retrospectively registered 20th December 2020.

The significance of wrist immobilization for endoscopic carpal tunnel release

“…To minimize the complications, some surgeon traditionally immobilizes the wrist in question for 1-4 weeks after OCTR (25,26). An increasing body of evidence suggests that wrist immobilization following OCTR is ineffective and adversely affects postoperative rehabilitation (10-13, 16, 17, 19).…”

“…Though significant emphasis has been put on the strengths and limitations between ECTR and open carpal tunnel release (OCTR) ( 5 – 8 ), the postoperative protocol has been largely understudied. To minimize the complications, some surgeon traditionally immobilizes the wrist in question for 1–4 weeks after OCTR ( 25 , 26 ). An increasing body of evidence suggests that wrist immobilization following OCTR is ineffective and adversely affects postoperative rehabilitation ( 10 – 13 , 16 , 17 , 19 ).…”

Surgical Interventions for the Management of Carpal Tunnel Syndrome: A Narrative Review

“…This new technique, compared to OCTR, showed a decreased risk of developing trauma, better safety, and is more effective and feasible to be performed in low-level healthcare facilities. For its simplicity and short learning curve, it should be more widespread in CTS management [ 23 ].…”

“…The OCTR group experienced a higher incidence of wound complications (OR 1.97, 95% CI 1.74-2.23) and readmission at 30 days (OR 1.89, 95% CI 1.73-2.06). In addition to that, the high reimbursement cost of ECTR ($310.60 ± $1639.57, P<0.001) is considered a disadvantage of this technique, but considering the overall superiority of ECTR, it could be considered worth the financial charges [ 23 , 34 ].…”

A Clinical Outcome of Median Nerve Neurolysis For the Treatment of Carpal Tunnel Syndrome: Conventional S-Shaped Versus Transwrist Mini-Incision Techniques

“…However, it had a long incision and higher complication rate [e.g., wound infection or painful scar]. Some patients have a limitation of their wrist movement due to hyperplastic scar and pain, and some need a secondary surgery [9,10] .…”