Efficacy of Keyhole Approach to Carpal Tunnel Syndrome under Ambulatory Strategy

Abstract

The carpal tunnel syndrome is one of the most common entrapment neuropathies found in humans. Currently, the gold standard is surgical treatment using different modalities. The minimally invasive strategy with high resolution capacity and less morbidity is still a challenge. Methods. Prospective nonrandomised clinical trial in which a minimally invasive microsurgical approach was used following the keyhole principle in 55 consecutive patients and 65 hands under local anesthesia and ambulatory strategy. They were evaluated with stringent inclusion criteria with the Levine severity and functional status scale and with a 2-year follow-up. Results. 90% showed immediate improvement dropping to grades 1-2 in all items of the scale referring to pain and numbness. 97% reported improvement, as of the first month, and 3% reported persistence of symptoms, although at a lesser degree and with no functional limitation. No incidents were identified during the procedure and 98% of patients were discharged within an hour after the surgical procedure. Conclusions. The microsurgical approach described following the keyhole principle is a treatment option that, under local anesthesia and ambulatory management, may represent an alternative strategy of an effective treatment reducing the morbidity. This trial is registered with Clinical Trials Protocol Identifier NCT03062722.

Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release

“…From the 506 titles and abstracts identified in the searches, we fully reviewed 106 articles where the primary reasons for exclusion were retrospective study design (30), insufficient sample size (29), or the lack of information on the specific CTR technique (12). The meta-analysis included 23 studies, 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 involving 2,303 patients from 15 countries, representing a best-evidence synthesis of mOCTR literature published over the past decade ( Supplementary Figure 1 ). The median age of participants was 55 years (study-wide range was 35–63 years), most were women (median 74%; study-wide range was 50%–100%), and the median CTS symptom duration before surgery was 12 months (study-wide range was 5–57 months; Table 1 ).…”

Comparison of Carpastretch® With Splint in Non-Surgical Treatment of Carpal Tunnel Syndrome: A Randomized Open Label Study

“…This study is also an answer to recommendations for further investigation of non-surgical treatments for CTS. 2,[17][18][19][20][21][22][23] This was the first hospital based randomized trial of CarpaStretch ® device compared with the conventional wrist splint for patients with CTS. During the 6 months of the study, and the 12-month follow-up, the anatomical and functional changes noted may be increase in sensory NCV and improvement in CTS severity at 6 months, small but clinically meaningful improvements in carpal tunnel transverse diameters (median nerve, bony proximal and soft tissue) at 6 months, reduced incidence and increased time to paraesthesia over 12 months, improved Boston Carpal Tunnel Syndrome Questionnaire and WHO-QOL (physical domain) scores over 12 months.…”