Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial

Abstract

Objectives To compare endoscopic and open carpal tunnel release surgery among employed patients with carpal tunnel syndrome. Design and setting Randomised controlled trial at a single orthopaedic department. Participants 128 employed patients aged 25-60 years with clinically diagnosed and electrophysiologically confirmed idiopathic carpal tunnel syndrome. Main outcome measures The primary outcome was severity of postoperative pain in the scar or proximal palm and the degree to which pain or tenderness limits activities, each rated on a 4 point scale, transformed into a combined score of 0 (none) to 100 (severe pain or tenderness causing severe activity limitation). The secondary outcomes were length of postoperative work absence, severity of symptoms of carpal tunnel syndrome and functional status scores, SF-12 quality of life score, and hand sensation and strength (blinded examiner); follow-up at three and six weeks and three and 12 months. Results 63 patients were allocated to endoscopic surgery and 65 patients to open surgery, with no withdrawals or dropouts. Pain in the scar or proximal palm was less prevalent or severe after endoscopic surgery than after open surgery but the differences were generally small. At three months, pain in the scar or palm was reported by 33 patients (52%) in the endoscopic group and 53 patients (82%) in the open group (number needed to treat 3.4, 95% confidence interval 2.3 to 7.7) and the mean score difference for severity of pain in scar or palm and limitation of activity was 13.3 (5.3 to 21.3). No differences between the groups were found in the other outcomes. The median length of work absence after surgery was 28 days in both groups. Quality of life measures improved substantially. Conclusions In carpal tunnel syndrome, endoscopic surgery was associated with less postoperative pain than open surgery, but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain.

Osteoarticular complications related to HIV infection and highly active antiretroviral therapy

“…During moderate to severe stages, surgical treatment is indicated. This can be performed either in the conventional way or endoscopically [20,21]. In both procedures the median nerve is decompressed through the opening of the flexor retinaculum.…”

Short-Term Outcomes after Median Nerve Release for Carpal Tunnel Syndrome

“…Some series show satisfactory resuls at one and three weeks after surgery [13,15] . However, our aim was to go one step further evaluating how soon the patient actually experiences this improvement.…”

“…It is known that surgical release of median nerve can decrease pain, improve grip strength and furthermore, patients' expectations meet with the surgical outcomes [12][13][14] this results can be evaluated even one week after surgery [15] . Functional results are usually evaluated in medium term being 3, 6 and 12 months after surgery the most common periods [15][16][17][18][19] .…”

Chiropractic management of work-related upper limb disorder complicated by intraosseous ganglion cysts: a case report

“…The effectiveness of endoscopic and open surgery for CTS was demonstrated in a randomized clinical trial. 19 Another study found that most postsurgical complications may be attributed to technical errors during the initial procedure. 20 The presence of CTS with ganglion cysts has been shown to result in deafferentation and motor deficits.…”