Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis

Abstract

BackgroundThe Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather “blind” procedure and on the high number of severe complications that have been reported in the literature.PurposeTo evaluate whether there is evidence supporting a higher risk after ECTR in comparison to the conventional open release.MethodsWe searched MEDLINE (January 1966 to November 2013), EMBASE (January 1980 to November 2013), the Cochrane Neuromuscular Disease Group Specialized Register (November 2013) and CENTRAL (2013, issue 11 in The Cochrane Library). We hand-searched reference lists of included studies. We included all randomized or quasi-randomized controlled trials (e.g. study using alternation, date of birth, or case record number) that compare any ECTR with any OCTR technique. Safety was assessed by the incidence of major, minor and total number of complications, recurrences, and re-operations.The total time needed before return to work or to return to daily activities was also assessed. We synthesized data using a random-effects meta-analysis in STATA. We conducted a sensitivity analysis for rare events using binomial likelihood. We judged the conclusiveness of meta-analysis calculating the conditional power of meta-analysis.ConclusionsECTR is associated with less time off work or with daily activities. The assessment of major complications, reoperations and recurrence of symptoms does not favor either of the interventions. There is an uncertain advantage of ECTR with respect to total minor complications (more transient paresthesia but fewer skin-related complications). Future studies are unlikely to alter these findings because of the rarity of the outcome. The effect of a learning curve might be responsible for reduced recurrences and reoperations with ECTR in studies that are more recent, although formal statistical analysis failed to provide evidence for such an association. Level of evidence: I.

Ultrasound, Clinical, and Electrophysiological Findings in Persistent Carpal Tunnel Syndrome

“…A recent meta-analysis highlighted the lack of statistical difference of the complication rate (especially, incidence of reoperation and traumatic neuroma) among open and endoscopic carpal tunnel releases. 23 In view of these data, we consider that the incidence rate of scar tissue or neuroma formation documented in our study sample is in line with previous reports. 17,18 In addition, the clinical data collection was reliant on patient self-report (BCTSQ), which is open to recall bias, and data quality could not be independently verified.…”

“…The small study sample allowed no further evaluation of possible, statistical differences of findings among study subpopulations, such as cases with neuroma formation or entrapment caused by scar tissue formation. A recent meta‐analysis highlighted the lack of statistical difference of the complication rate (especially, incidence of reoperation and traumatic neuroma) among open and endoscopic carpal tunnel releases . In view of these data, we consider that the incidence rate of scar tissue or neuroma formation documented in our study sample is in line with previous reports .…”

Ultrasound‐Guided Incisionless Carpal Tunnel Release Using a Hook Knife: A Cadaveric Study

“…Common carpal tunnel surgical release approaches include open and endoscopic carpal tunnel release (CTR). Open CTR, the most commonly performed procedure, requires a 6‐8 cm incision to visualize the complete TCL and surrounding neurovascular structures, whereas endoscopic CTR requires a smaller single or double skin incision (1‐2 cm) for instrumentation. Advantages of endoscopic CTR include reduced incidence of postoperative surgical scar tenderness, neuroma formation, wound, and skin related complications and early return to work .…”

“…Open CTR, the most commonly performed procedure, requires a 6‐8 cm incision to visualize the complete TCL and surrounding neurovascular structures, whereas endoscopic CTR requires a smaller single or double skin incision (1‐2 cm) for instrumentation. Advantages of endoscopic CTR include reduced incidence of postoperative surgical scar tenderness, neuroma formation, wound, and skin related complications and early return to work . However, endoscopic CTR is limited by a narrow endoscopic field of view, a steep learning curve, higher risk of iatrogenic injuries, transient neurapraxia due to blind insertion of the trocar, and inability to visualize the distal margin of TCL increasing the likelihood of incomplete release …”

“…Advantages of endoscopic CTR include reduced incidence of postoperative surgical scar tenderness, neuroma formation, wound, and skin related complications and early return to work . However, endoscopic CTR is limited by a narrow endoscopic field of view, a steep learning curve, higher risk of iatrogenic injuries, transient neurapraxia due to blind insertion of the trocar, and inability to visualize the distal margin of TCL increasing the likelihood of incomplete release …”