Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

Paryavi, Ebrahim; Zimmerman, Ryan M.; Means, Kenneth R.

doi:10.2106/jbjs.rvw.15.00071

Cited by 7 publications

(7 citation statements)

References 30 publications

(36 reference statements)

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“…The finding of our meta-analysis of RCTs suggest that patients treated with ECTR returned to work or daily activities earlier than those treated with OCTR. Consistent with our results, Vasiliadis et al (21) and Paryavi et al (52) reported that patients who underwent ECTR experienced less surgical trauma than those who underwent an open technique, and this resulted in less time off work, faster recovery, and better performance of daily activities. However, regarding the RTW data, we noticed that divergences between the studies resulted in large between-study heterogeneity.…”

Section: Discussionsupporting

confidence: 92%

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Luo

et al. 2020

Preprint

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Background Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial. MethodsWe comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR. Results Twenty-eight studies were included in our meta-analysis. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, -7.25 days; 95% CI, -14.31 to -0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). There were no significant differences between the two methods in terms of permanent nerve injury (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28). Conclusions Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions than OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.

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Section: Discussionsupporting

confidence: 92%

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Luo

et al. 2020

Preprint

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“…The finding of our meta-analysis of RCTs suggest that patients treated with ECTR returned to work or daily activities earlier than those treated with OCTR. Consistent with our results, Vasiliadis et al [22] and Paryavi et al [52] reported that patients who underwent ECTR experienced less surgical trauma than those who underwent an open technique, and this resulted in less time off work, faster recovery, and better performance of daily activities. However, regarding the RTW data, we noticed that divergences between the studies resulted in large between-study heterogeneity.…”

Section: Discussionsupporting

confidence: 92%

“…Since the development of ECTR by Chow (12) and Okutsu et al [13] in 1989, there has been controversy regarding the superiority of ECTR over OCTR. Accordingly, many original articles have been published on this issue; moreover, several meta-analyses have compared ECTR with OCTR as treatment options for CTS [14,15,[21][22][23][51][52][53]. However, previous meta-analyses included fewer studies than ours, did not classify the data into subgroups according to different follow-up times, featured only a few assessments of patient outcome, and included central tendency data but not standard deviation.…”

Section: Discussionmentioning

confidence: 99%

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Luo

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial. Methods: We comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR. Results: Twenty-eight studies were included in our meta-analysis. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, -7.25 days; 95% CI, -14.31 to -0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). There were no significant differences between the two methods in terms of permanent nerve injury (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28). Conclusions: Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions than OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.

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“… 14 The AAOS American Academy conducted a review of the literature and concluded that there was strong evidence recommending surgical treatment of carpal tunnel syndrome by fully opening the flexor retinaculum regardless of the surgical technique chosen. 1 , 15 …”

Section: Discussionmentioning

confidence: 99%

How Do Board-Certified Hand Surgeons Manage Carpal Tunnel Syndrome? A National Survey

et al. 2018

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Objective:To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists. Methods:This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed. Results:Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days. Conclusion:The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

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Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

Cited by 7 publications

References 30 publications

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

How Do Board-Certified Hand Surgeons Manage Carpal Tunnel Syndrome? A National Survey

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