Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome

Abstract

The advantages and disadvantages of endoscopic compared with open carpal tunnelreleasearecontroversial. We have performed a prospective, randomised, blinded assessment in a district general hospital in order to determine if there was any demonstrable advantage in undertaking either technique. Twenty-five patients with confirmed bilateral idiopathic carpal tunnel syndrome were randomised to undergo endoscopic release by the single portal Agee technique to one hand and open release to the other. Independent preoperative and postoperative assessment was undertaken by a hand therapist who was blinded to the type of treatment. Follow-up was for 12 months. The operating time was two minutes shorter for the open technique (p < 0.005). At all stages of postoperative assessment, the endoscopic technique had no significant advantages in terms of return of muscle strength and assessment of hand function, grip strength, manual dexterity or sensation. In comparison with open release, single-portal endoscopic carpal tunnel release has a similar incidence of complications and a similar return of hand function, but is a slightly slower technique to undertake.

Carpal Tunnel Syndrome

“…Both findings were supported in some of the prospective studies conducted comparing the two techniques 21,26 but not in others. [22][23][24][25] No difference in return to work data was found in some studies 23,24 despite greater short-term pain in the ECTR groups. Differences in symptom severity scores, functional status, and satisfaction consistently normalized by 1 year.…”

“…In an attempt to resolve this issue, numerous prospective randomized trials have been reported comparing ECTR to OCTR. [21][22][23][24][25] The most consistent arguments made in favor of ECTR have been less postoperative pain than OCTR and a shorter return to functional activities, particularly preoperative work status. Both findings were supported in some of the prospective studies conducted comparing the two techniques 21,26 but not in others.…”

Results of Endoscopic Carpal Tunnel Release Relative to Surgeon Experience With the Agee Technique

“…9,16 -20 These differences were found to normalize at 1 year. [21][22][23] Endoscopic carpal tunnel release has become an accepted treatment alternative to OCTR. Even in light of the above data, concern has been expressed that results of ECTR are limited by the surgeon's experience.…”

Short-Term Results of Endoscopic (Okutsu Method) Versus Palmar Incision Open Carpal Tunnel Release: A Prospective Randomized Controlled Trial

“…The other eight studies found no difference between groups 9−13,15 −17) . Five of the reports 9,13,14,16,17) des cribed improvements in sensation, but no significant differences were seen in any of the studies. Three reports 9,10,16) described electrophysiological findings, also without any significant difference.…”

“…In the ECTR group, surgery was performed without a tourniquet according to the methods of Okutsu et al 13) . In the OCTR group, tourniquets were used with all patients and a 3 -cm vertical incision was made in the palm (Fig.…”