Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis (original) (raw)
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Carpal Tunnel Release Surgery- A Systematic Review of Open and Endoscopic Approaches
Anesthesiology and Pain Medicine, 2020
Context: Carpal tunnel syndrome (CTS) is the most frequent peripheral compression-induced neuropathy observed in patients worldwide. Surgery is necessary when conservative treatments fail and severe symptoms persist. Traditional Open carpal tunnel release (OCTR) with visualization of carpal tunnel is considered the gold standard for decompression. However, Endoscopic carpal tunnel release (ECTR), a less invasive technique than OCTR is emerging as a standard of care in recent years. Evidence Acquisition: Criteria for this systematic review were derived from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two review authors searched PubMed, MEDLINE, and the Cochrane Database in May 2018 using the following MeSH terms from 1993-2016: ‘carpal tunnel syndrome,’ ‘median nerve neuropathy,’ ‘endoscopic carpal tunnel release,’ ‘endoscopic surgery,’ ‘open carpal tunnel release,’ ‘open surgery,’ and ‘carpal tunnel surgery.’ Additional sources, including Google Scho...
Open versus Endoscopic Carpal Tunnel Release: A Meta-analysis of Randomized Controlled Trials
Background Carpal tunnel syndrome is a common com-pressive neuropathy of the median nerve. The efficacy and safety of endoscopic versus open carpal tunnel release remain controversial. Questions/purposes The purpose of this study was to determine whether endoscopic compared with open carpal tunnel release provides better symptom relief, validated outcome scores, short-and long-term strength, and/or digital sensibility; entails a differential risk of complications such as nerve injury, scar tenderness, pillar pain, and reoperation; allows an earlier return to work; and takes less operative time. Methods The English-language literature was searched using MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials that compared endoscopic and open carpal tunnel release were included in the meta-analysis. Methodologic quality was assessed with the Consolidated Standards Of Reporting Trials (CONSORT) checklist, and a sensitivity analysis was performed. Symptom relief, Boston Carpal Tunnel Questionnaire (BCTQ) scores, strength, digital sensibility, complications, reoperation, interval to return to work, and operative time were analyzed. Twenty-one randomized controlled trials containing 1859 hands were included. Results Endoscopically treated patients showed similar symptom relief and BCTQ scores; better early recovery of grip strength (mean difference [MD], 3.03 kg [0.08–5.98]; p = 0.04) and pinch strength (MD, 0.77 kg [0.33–1.22]; p \ 0.001) but no advantage after 6 months; lower risk of scar tenderness (risk ratio [RR], 0.53 [0.35–0.82]; p = 0.005); higher risk of nerve injury (RR, 2.84 [1.08–7.46]; p = 0.03), most of which were transient neurapraxias. Similar risk of pillar pain and reoperation; an earlier return to work (MD, À8.73 days [À12.82 to À4.65]; p \ 0.001); and reduced operative time (MD, À4.81 minutes [À9.23 to À0.39]; p = 0.03). Conclusions High-level evidence from randomized controlled trials indicates that endoscopic release allows earlier return to work and improved strength during the early postoperative period. Results at 6 months or later are similar according to current data except that patients undergoing endoscopic release are at greater risk of nerve injury and lower risk of scar tenderness compared with open release. While endoscopic release may appeal to patients who require an early return to work and activities, surgeons should be cognizant of its elevated incidence of transient nerve injury amid its similar overall efficacy to open carpal tunnel release. Additional research is required to define the learning curve of endoscopic release and clarify the influence of surgeon volume on its safety.
Outcomes of open and endoscopic carpal tunnel release: a meta-analysis
HAND, 2012
Background Currently, there are two genres of surgical treatment of carpal tunnel syndrome, open versus endoscopic. The goal of our study is to analyze published data by comparing outcomes of surgical treatment for carpal tunnel syndrome and determine if one approach is superior to the other (open versus endoscopic). Methods A meta-analysis of retrospective series of Carpal tunnel release including >20 patients, with results measuring outcomes based on at least six of the following nine parameters (paresthesia relief, scar tenderness, two-point discrimination, thenar muscle weakness, Semmes-Weinstein/SW monofilament testing, return to work time, grip and pinch strength, and complications). Results Endoscopic carpal tunnel approach showed statistically superior outcomes in eight of the nine categories investigated. Only in the category of complications (mean occurrence of 1.2 % in the open release versus 2.2 % in the endoscopic release group) was the endoscopic group inferior.
Open versus Endoscopic Release of Carpal Tunnel Syndrome
2018
A total of 90 hands belonging to 80 patients were included in the study. They were mostly female (70) and the rest were male (10). There were 30 endoscopic releases, 60 open releases, and 2 endoscopic converted to open release. There were 15 hands complications in 90 hands. The overall complication rate was 12.2%. Complications noted were pillar pain, open tendonitis presenting as De Quervain disease or trigger finger (1 endoscopic surgeries, 1 open surgeries), infection (1 endoscopic surgeries, 3 open surgeries), wound adhesion (3 open surgeries), nerve injury (2 open surgery, 1 endoscopic), complex regional pain syndrome (4 open surgery), and scheduled returns to the operating room (OR) for recurrent, ongoing, or worsening symptoms (1 endoscopic surgeries, 5 open surgeries). 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. There were 12 patients (out of 90) in the surgery group had painful or hypertrophic scar or pillar pain. Wound adhesion and pillar pain was the only statistically significant complication found in the study when comparing open with endoscopic carpal tunnel release. This can potentially be prevented in future patients by delaying the removal of sutures and prolonging the use of a protective dressing in patients who undergo open release. There was not a statistically significant increase in overall complications when using the minimally invasive method of release, which is consistent with existing literature.
European Journal of Orthopaedic Surgery & Traumatology, 2015
This prospective randomized study aims at evaluating the electrophysiological results of endoscopic and open carpal ligament release in patients with carpal tunnel syndrome. Included in the study were 41 patients diagnosed with carpal tunnel syndrome (21 hands in the endoscopic group and 20 hands in the open group). The Boston questionnaire was administered preoperatively and postoperatively to the patients, and their functional capacities and symptom severities were recorded. Physical examination was carried out preoperatively and in the postoperative sixth month. Demographic data and preoperative Boston symptomatic and functional scores were similar between both groups. A significant improvement was obtained in the Boston symptomatic and functional scores of both groups, but no significant difference was found between the groups in terms of improvement in the symptomatic and the functional scores. A significant shortening in median nerve motor distal latency and an increase in the velocity of sensory conductions were determined in both groups in the postoperative electromyography, but no difference was found between them in terms of improvement in the electromyography values. It was shown both clinically and electrophysiologically that endoscopic carpal tunnel surgery was as effective as open surgery as a treatment method for carpal tunnel syndrome.
Endoscopic Versus Open Carpal Tunnel Release
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2010
Purpose: This study compared endoscopic carpal tunnel release with the conventional open technique with respect to short-and long-term improvements in functional and clinical outcomes. Methods: We assessed 72 outpatients diagnosed with carpal tunnel syndrome. Of these patients, 37 underwent the endoscopic method according to Chow and 35 were assigned to the open method. Improvement in symptoms, severity, and functionality were evaluated at 2 days, 1 week, 2 weeks, and 1 year postoperatively. Changes in clinical outcomes were evaluated at 1 year postoperatively. Complications were also assessed. Results: Both groups showed similar improvement in all but 1 outcome 1 year after the release; increase in grip strength was significantly higher in the endoscopic group. However, the endoscopic method showed a greater improvement in symptoms and functional status compared with the open method at 2 days, 1 week, and 2 weeks postoperatively. Separate analysis of the questions referring to pain showed that the delay in improvement in the open group was because of the persistence of pain for a longer period. Paresthesias and numbness decrease immediately after the operation with comparable rates for both groups. Conclusions: Endoscopic carpal tunnel release provides a faster recovery to operated patients for the first 2 weeks, with faster relief of pain and faster improvement in functional abilities. Paresthesia and numbness subside in an identical manner with the 2 techniques. At 1 year postoperatively, both open and endoscopic techniques seem to be equivalently efficient. Level of Evidence: Level II, prospective comparative study.
Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome
British Journal of Surgery, 2001
Background: Carpal tunnel syndrome (CTS) is a common disorder for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment. The object of this systematic review is to compare the ef®cacy of the various surgical techniques in relieving the symptoms of CTS and promoting return to work and/or activities of daily living. Methods: Computer-aided searches of Medline, EMBASE and the Cochrane Controlled Trials Register were conducted, together with reference checking. A rating system, based on the number of studies and their methodological quality and ®ndings, was used to determine the strength of the available evidence for the ef®cacy of the treatment. Results: Fourteen studies were included in the review. None of the alternatives to standard open carpal tunnel release (OCTR) seems to offer better relief of symptoms. There is con¯icting evidence about whether endoscopic carpal tunnel release results in earlier return to work and/or activities of daily living. Conclusion: Standard OCTR is still the preferred method of treatment for CTS. It is just as effective as the alternatives, but is technically less demanding, so incurs a lower risk of complications and of added costs.
Indications, Surgical Techniques and Safety of Open VersusEndoscopic Carpal Tunnel Release
2020
Carpal tunnel syndrome (CTS) is the most prevalent focal neuropathy affecting the median nerve. The disorder arises when the median nerve in the wrist is compressed and this condition is more common in females than in males. The syndrome is characterized by pain in the hand, numbness and tingling in the distribution of the median nerve. These sensations may be felt in the thumb, index finger, middle finger and the radial side of the ring finger. The treatment of carpal tunnel syndrome (CTS) should be selected considering the stage of the disease, the severity of the symptoms, or patient's preference. Non-surgical treatments include wrist splinting, change of working position, medications and use of alternative non-vibrating equipment at work. On the other hand, surgical methods include open release and endoscopic surgeries. Surgery is a treatment for patients that have severe median nerve damage that includes permanent sensory and motor loss under electro-diagnostic studies. The open carpal release is the most used form of curative therapy when decompressing the median nerve. ECTR is expected to have better outcomes in terms of pain, speed of healing and return to normal activities. Although injuries are rare during and after surgery, several complications related to the branches attached to the median nerve and ulnar artery could arise. Therefore, sufficient surgical techniques, as well as a comprehension of the wrist anatomy, are essential to ensure the carpal tunnel release surgery is safe.
Revista brasileira de ortopedia
The authors performed an intra-individual comparison of surgical results between the open and endoscopic surgical techniques in patients with bilateral carpal tunnel syndrome. Each hand was submitted to surgery using one of these techniques. Fifteen patients (30 hands) were evaluated by the Boston Questionnaire, visual analogue pain scale, palmar grip strength, and for tip, key, and tripod pinch strengths. These measurements were taken before surgery and at two weeks, one month, three months, and six months after the procedure. Scores for each evaluation tool in each evaluation time period were compared. In comparison to the group submitted to open surgery, the group submitted to endoscopic surgery had worse scores in the evaluation of the 1st and 6th postoperative months regarding the severity of the symptoms. The authors found no differences in the functional status of the hand. Regarding the intensity of pain evaluated by the visual analogue pain scale, no difference was found be...