Mini-Open versus Extended open Release for Severe Carpal Tunnel Syndrome

Murthy, Praveen G.; Goljan, Peter; Mendez, Gregory M; Jacoby, Sidney M.; Shin, Eon K.; Osterman, A. Lee

doi:10.1007/s11552-014-9650-x

Cited by 21 publications

(21 citation statements)

References 38 publications

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“…An additional strength of this study is that each patient received the same intervention (mini-open CTR) performed by the same surgeon, which further limited confounding factors. Previous descriptions of the advantages of the mini-open approach have been published [8,9], but they either had a shorter follow-up or a smaller sample than this study. In our study, 11% of patients suffered from an early complication (within 3 months post-intervention) (Table 6), which is in accordance with the published rates in the literature, which range from 1% to 25% [10].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of mini-open carpal tunnel release: An outcome study

2019

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Background Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy with a high morbidity and healthcare-related costs. Currently there is no consensus about the best treatment option. The purpose of this prospective cohort study conducted at a single institution was to evaluate the clinical outcomes and patient satisfaction following a mini-open carpal tunnel release for idiopathic CTS. Methods A total of 72 patients (53 female and 19 male patients; mean age, 57.8±15.3 years; range, 24–94 years) had a mini-open carpal tunnel release performed by a single senior surgeon between June 2015 and June 2016. The patients were evaluated preoperatively, and at 3 and 12 months post-intervention. At every follow-up, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and visual analogue scale (VAS) scores for pain and satisfaction were completed. Digital sensibility (using Semmes- Weinstein monofilaments) was assessed and pinch and grip strengths were measured. Results Statistically significant and clinically relevant improvement was found in terms of digital sensibility, grip and pinch strength (except for 2-point pinch), BCTSQ scores and pain scores. The complication rate was minimal, and no major complications occurred. Two patients experienced recurrence. The availability of follow-up records (including patient-reported outcomes, BCTSQ and VAS scores, and the complication rate) at 1-year post-intervention varied between 69% and 74% (50–53 patients) depending on which parameter was assessed. Patient satisfaction was high (mean, 80.9±26.0; range, 0–100). Conclusions This study demonstrates that mini-incision carpal tunnel release is clinically effective in the short and long term.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of mini-open carpal tunnel release: An outcome study

2019

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“…The main complaint of the patients was about the scar of the surgery and the date of starting to use their hand in daily activities and return to work. 5,6,9,11,14,15,[18][19][20] Therefore, the later points were of interest for clinical analysis of the results of this study. The differences between both groups were statistically significant regarding the operative data.…”

Section: Resultsmentioning

confidence: 99%

Limited mid palmar versus extended incision in surgical treatment of carpal tunnel syndrome: Clinical analysis

et al. 2020

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Background and objective: There are different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. This study aimed to compare the surgical outcome of the conventional extended incision with the limited mid palmar one. Methods: The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into two groups: Group 1 was patients operated on by the conventional extended incision, Group 2 with a limited mid palmar incision. Results: The patients included were 79 with 89 hands. The age mean was 41 years. Group 1 included 47, and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities, and return to work). However, the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications that occurred for the cases of Group 2 was about a third of that occurred for Group 1. The highly significant difference was in the scar tenderness in the third month of the post-operative period. Conclusion: The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, earlier use of the hand in daily life activities, and return to work in a shorter period. Keywords: Carpal tunnel syndrome; Surgical treatment; Incision.

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“…Superiority among open or mini-open techniques for carpal tunnel release remains highly controversial in the orthopedic literature and among surgeons. Using a retrospective study, Murthy et al[ 7 ] reported no significant differences between the two procedures with regard to patient-rated symptom severity or functional status outcomes. Although this study presented a large cohort of severe CTS patients, they were not adequately matched between the two groups with regard to age, gender and preoperative electrodiagnostic testing.…”

Section: Discussionmentioning

confidence: 99%

“…The literature is virtually silent regarding comparison of mini-open and extended open release for CTS. To our knowledge, the only study by Murthy et al[ 7 ] compared these two approaches in patients with severe CTS. The confounding data in this study regarding severity of nerve compression that can be determined by electrodiagnostic testing let us design a matched-pair analysis to compare mini-open and extended open release techniques.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two approaches for carpal tunnel release: Extended versus mini-open technique

et al. 2020

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Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper extremity, which develops as a result of compression of median nerve at the level of wrist. [1] The ideal surgical decompression method remains controversial and has inspired less invasive techniques such as endoscopy-assisted tunnel release (ECTR) and ultrasound-guided methods. While there are many purported advantages of ECTR, such as better patient comfort and early recovery period, ECTR and open approaches have similar long-term outcomes. [2] The classical approach of decompression is open release of the carpal tunnel. Phalen [3] first reported his experience and results of open carpal tunnel surgery in 1966. The classical surgical incision of the open carpal tunnel surgery extends from Kaplan's cardinal line (KCL) to wrist crease. This extended technique prevents inadequate decompression by visualization of the surgical site both proximally and distally. However, many surgeons favor shorter incisions due to unsettling scar formation after extended approach. Also, the mini-open technique has been shown to produce lower recurrence and shorter recovery period with obvious reduction in pain and Objectives: This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). Patients and methods: The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1: mini-open and group 2: extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure preand postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. Results: Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. Conclusion: Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.

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Mini-Open versus Extended open Release for Severe Carpal Tunnel Syndrome

Abstract: Background This study aims to compare surgical outcomes of severe carpal tunnel syndrome (CTS) treated with miniincision versus extensile release. Methods The method employed in this study was a retrospective review of patients with severe

Cited by 21 publications

References 38 publications

Effectiveness of mini-open carpal tunnel release: An outcome study

Effectiveness of mini-open carpal tunnel release: An outcome study

Limited mid palmar versus extended incision in surgical treatment of carpal tunnel syndrome: Clinical analysis

Comparison of two approaches for carpal tunnel release: Extended versus mini-open technique

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