The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome

Li, Gaocen; Kong, Lingde; Kou, Ningzhao; Wang, Yanxue; Yu, Kaijiang; Bai, Jing; Tian, Dehu

doi:10.1097/md.0000000000015372

Cited by 11 publications

(11 citation statements)

References 31 publications

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“…This randomized controlled trial demonstrated that there were no differences in terms of early postoperative anterior wrist pain or time to return to work or to activities of daily living between the MIS with tool-kit and the short incision patients who underwent CTS release. Our results differ significantly from a recent meta-analysis [ 15 ]. Among the reasons for the difference might be the relatively small difference in wound length between the MIS with tool-kit and the short incision groups (1.95 (SD 0.47) cm vs 2.92 (SD 0.56) cm) in this study which had small effect size.…”

Section: Discussioncontrasting

confidence: 99%

“…Meta-analyses of previous publications have reported no significant difference in terms of symptom relief or functional improvement in the short- or long-term between open and endoscopic carpal tunnel release [ 11 – 13 ]. However, earlier return to work or activities of daily living and lower scar-related complications were found in smaller incision group with large difference of surgical wound length (open versus endoscopic carpal tunnel release or limited-incision versus standard-incision) [ 11 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta-analysis reported that a limited incision allows an earlier return to normal activities than the standard incision [ 15 ]. There were, however, some methodological flaws in that meta-analysis, e.g., it included retrospective studies and non-randomized studies which contained some bias [ 17 , 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities

Atthakomol

Kaensuk²,

Manosroi³

et al. 2022

BMC Musculoskelet Disord

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Trial design The prospective randomized controlled trial. Background This study compares outcomes in terms of early postoperative anterior wrist pain and time to return to work or activities of daily living of patients who underwent carpal tunnel syndrome (CTS) release with short incision and those who had minimally invasive surgery (MIS) with CTS kits. Methods A total of 24 patients diagnosed with primary CTS confirmed with electrodiagnosis at an academic university hospital were randomly assigned into one of two groups of 12 patients each: a short incision group and an MIS with tool-kit group using computer-generated block randomization (block of four). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. In the short incision group, skin was incised longitudinally from Kaplan’s line to the area distal to transverse wrist crease (2.5–4.0 cm) while in the tool-kit group, an incision of less than 2.5 cm. was made using special MIS-CTS kits. Primary outcomes evaluated include visual analogue scale (VAS) measurement of pain intensity in the anterior carpal area both while at rest and while conducting daily activities at the 2nd week postoperatively as well as the time to return to activities of daily living and work. Improvement in the Michigan hand questionnaire (MHQ) score, a secondary outcome, was also measured at the 2nd week postoperatively. Patients, allocator and outcome assessor were blinded. Results Demographic data, including preoperative electrodiagnostic severity and occupation, were similar in the two groups. There were no significant differences in terms of VAS of the early postoperative anterior carpal area at rest (p > 0.99), while conducting daily activities (p = 0.89) and time to return to activities of daily living (p = 0.46) and work (p = 0.24). The MHQ score improvement at the 2nd week postoperatively showed no significant difference between the groups (p = 0.95). The MIS wound length in the tool-kit group was significantly shorter than in the short incision group (1.95 vs 2.92 cm, p < 0.01). Conclusions There is no difference in early postoperative anterior wrist pain, time to return to work or to activities of daily living between the surgical techniques. Short incision is recommended for benefit in term of cost-effectiveness, while MIS with tool-kit could be preferred in patients who concerned in cosmetic appearance between the surgical techniques. Trial registration www.clinicaltrials.in.th (TCTR20200530003). Registered 30 May 2020.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities

Atthakomol

Kaensuk²,

Manosroi³

et al. 2022

BMC Musculoskelet Disord

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“…The high heterogeneity was mainly because of the fact that the data compared mini-incisions with endoscopic incisions. Miniincisions are not directly comparable to the standard incisions in OCTR, as they yield a better appearance and tend to have fewer wound-related complications than standard incisions [58].…”

Section: Discussionmentioning

confidence: 99%

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

Luo

et al. 2020

BMC Musculoskelet Disord

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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. 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: Our meta-analysis contained twenty-eight studies. 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 scarrelated complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). The permanent nerve injury showed no significant differences between the two methods (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 compared to 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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“…The high heterogeneity was mainly because of the fact that the data compared mini-incisions with endoscopic incisions. Mini-incisions are not directly comparable to the standard incisions in OCTR, as they yield a better appearance and tend to have fewer wound-related complications than standard incisions [55].…”

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

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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. 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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The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome

Cited by 11 publications

References 31 publications

Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities

Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities

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

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