Results of Open Carpal Tunnel Release: A Comprehensive, Retrospective Study of 188 Hands

Abstract

Background: Many recent reports of the results of decompression of the median nerve in the carpal tunnel have concentrated on only one aspect of recovery (numbness, grip etc.), and there are no reports of a comprehensive study of outcome. The aim of the present study was to review comprehensively the results of the direct visualization method of decompression of the carpal tunnel and to compare them with the published results of endoscopic release. Methods: Patients' perceptions of the severity of pain, numbness and paraesthesiae due to carpal tunnel syndrome (CTS), before and after open carpal tunnel release (CTR) in 188 hands were reviewed retrospectively at a minimum time of followup of 18 months. Motor and sensory testing, provocation testing and measurement of scar tenderness in 135 hands were performed at a clinical review. Results: Subjective results showed that 70% experienced a reduction in the severity of pain after CTR, 78% of hands experienced a reduction in the severity of paraesthesiae and 77% experienced a reduction in the severity of numbness. A total of 49% had improvements in all three symptoms after CTR. At the clinical review, sensory testing revealed that 59% of hands had normal or slightly diminished light touch, 35% had normal static two-point discrimination and 61% had normal dynamic twopoint discrimination. Results for Tinel's test, Phalen's test and pressure provocation testing were positive in 10% of hands. There was no scar tenderness in 38%, no persisting thenar atrophy in 90%. Normal grip strength was found in 93% and 91% had normal pinch strength. Conclusions: It was concluded that open carpal tunnel release remains a safe and reliable treatment for carpal tunnel syndrome. The very low incidence of serious complications from the open technique of CTR, when compared with endoscopic CTR as published by different authors in the literature, and the comparable clinical results, appears to make the open technique a safer and preferable option. However, a properly controlled trial of both techniques is necessary to compare them.

The Outcome of Carpal Tunnel Decompression in Elderly Patients

“…Many studies show complete relief or marked improvement in symptoms in 80% to 100% of patients. 7,8,13,14 Bland 3 commented that more widely based studies had lower satisfaction rates (70% to 90%). His large study showed success in 74% but 11.4% were worse after surgery.…”

Outcomes of open and endoscopic carpal tunnel release: a meta-analysis

“…A 1-cm volar incision is made through which visualization and identification of structures can be made and the release undertaken [16,21,34,41]. This method has delivered very promising results with complications at a rate of 4.7 %, but of which there were no nerve injuries and no long-term sequelae [9,16,21,22,34,40,42]. However, no publications from 1966 through 2006, reviewing outcome of "open minimal incision" type of CTR meeting our study inclusion criteria, were found (2006 Rab et al study with bilateral CTR randomized to open on one side and two portal endoscopic on the other side which did not meet inclusive criteria of this metaanalysis, because there were only 10 patients and parameter data was in non-standard units, but essentially reaffirmed its conclusions) [32].…”

The Thenar Index: An Objective Assessment and Classification of Thenar Atrophy Based on Static Hand Imprints and Clinical Implications

“…14,31 To standardize the visual assessment, some authors have either simplified the classification system (mild to moderate or severe; present or absent) or used the same examiner whenever possible. 8,12,13,[15][16][17][18][19]24,27,[32][33][34][35][36] However, even the latter may introduce a certain level of bias when the success of a treatment modality is being investigated. Furthermore, the evaluation is not sensitive enough to grade a partial improvement in atrophy.…”