Poor Outcome for Neural Surgery (Epineurotomy or Neurolysis) for Carpal Tunnel Syndrome Compared with Carpal Tunnel Release Alone: A Meta-Analysis of Global Outcomes (original) (raw)
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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.
BMC musculoskeletal …, 2006
Background: A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS), however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF). Methods: The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical treatment for CTS. The outcomes assessed in these trials were identified, classified and linked to the different domains of the ICF. Results: Twenty-eight studies were retrieved which met the inclusion criteria. The most frequently assessed outcomes were self-reported symptom resolution, grip or pinch strength and return to work. The majority of outcome measures employed assessed impairment of body function and body structure and a small number of studies used measures of activity and participation. Conclusion: The ICF provides a useful framework for identifying the concepts contained in outcome measures employed to date in trials of surgical intervention for CTS and may help in the selection of the most appropriate domains to be assessed, especially where studies are designed to capture the impact of the intervention at individual and societal level. Comparison of results from different studies and meta-analysis would be facilitated through the use of a core set of standardised outcome measures which cross all domains of the ICF. Further work on developing consensus on such a core set is needed.
International Orthopaedics, 2012
Purpose The purpose of this study was to evaluate the effects of epineurotomy on the post-surgical median nerve volume and clinical outcomes in carpal tunnel syndrome (CTS) patients with a prominent nerve narrowing. Methods This was a prospective, randomised, double-blind controlled trial. Patients (n050) were randomised (1:1) to open-field surgical carpal tunnel release followed by a longitudinal epineurotomy of the nerve (test), or to open-field release without epineurotomy (control). Results The nerve volume was slightly larger in the test group 90 days post-surgery (by 10.5 %, p00.157) but not 180 days post-surgery. No relevant electropyhsiological or clinical difference between groups and no effect of the nerve volume was observed. The subjective pain reduction was slightly more prominent in the control group at 180 days. Larger post-surgical nerve volume was associated with lower pain, but only in the control group. Conclusions Even in selected CTS patients, longitudinal epineurotomy confers no benefit regarding the nerve volume or clinical outcomes over a simple carpal tunnel release.
Tendencies in the post-surgical approach for carpal tunnel syndrome. Current clinical practice
Reumatología Clínica (English Edition), 2019
Background and objectives: Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. Material and methods: A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. Results: In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. Discussion and conclusions: There are no common criteria in the techniques used after surgical decompression of the median nerve.
Functional outcomes of 300 carpal tunnel release: 1.5 cm longitudinal mini-incision
Asian Journal of Neurosurgery, 2018
Objective: There is an opportunity for median nerve decompression by open surgery in carpal tunnel syndrome which is the most common surgical procedure in neurosurgical practice. The aim of this study is to evaluate the long-term outcomes of carpal tunnel release with 1.5 cm longitudinal mini-incision technique with regarding the effectiveness and safety. Methods: For this prospective study, 300 hands for 188 patients with advanced carpal tunnel syndrome who had indication for neurolysis underwent carpal tunnel release through a 1.5 cm longitudinal mini-incision between March 2011 and 2015. There were 132 (70%) females and 56 (30%) males with a mean age of 40 ± 29.5 years (ranging from 24 to 73) and female to male: About 2.56.178 operations were performed for the right hand and 122 for the left hand. Preoperatively, all patients were evaluated with clinical examination and nerve conduction studies. The clinical effects of the patients assessed with the Global Symptom Score (GSS) and...
BMJ Open, 2017
ObjectivesThe aim of this study was to evaluate one-stop surgery (OSS) for carpal tunnel syndrome (CTS) regarding symptom relief and patient satisfaction. OSS in our setting means only one visit to the hospital for surgery and no hospital appointments for preassessment or follow-up. We hypothesised that relief of symptoms with OSS is comparable with that in non-OSS patients reported in the literature.DesignThis is a long-term retrospective follow-up study (56.5 months) of 1003 patients referred for CTS and discharged with or without surgery from an OSS clinic. Of the original cohort, 671 patients completed the long-term follow-up telephone interview.ResultsTwo-thirds of the patients were free of even minor symptoms following surgery. The symptom relief and patient satisfaction in this study were comparable with results in non-OSS patients reported in the literature.ConclusionThe implementation of a clinical pathway and OSS for the management of CTS was safe with good long-term sympt...
Acta Neurochirurgica, 1985
In a series of patients with clinically and neurophysiologically well defined carpal tunnel syndrome a randomization has been made into two groups, one for operation with internal neurolysis and a microscopical technique, and the other group for cutting of the carpal ligament (flexor retinaculum) alone. The two groups have been compared postoperatively regarding clinical and neurophysiological parameters. All patients improved, 89% in both groups considered themselves totally free of symptoms at follow-up examinations but there was no significant difference in any parameter between the two groups. As a conclusion the use of internal neurolysis cannot be recommended as a routine procedure in carpal tunnel syndrome.
Evaluation of the Efficacy of Surgical Treatment of Carpal Tunnel Syndrome
Journal of Medical Sciences, 2017
Objective: To evaluate the efficacy of surgical treatment of carpal tunnel syndrome.Material and Methods: This prospective interventional study was conducted at Trauma and Orthopedic DepartmentKhyber Teaching Hospital, Peshawar, Pakistan from January 2014 to December 2014.Results: A total of 40 patients were included 04 (10%) male patients and 36 (90%) female patients. Pre op Boston CarpalTunnel Syndrome Questionnaire (BCTSQ) symptomatic part showed moderate disease in 5 patients (10.63%), severedisease in 32 patients (68.10%) and very severe disease in 10 patients (21.27%) while Pre op functional part showedmoderate disease in 7 patients (14.9%), severe disease in 29 patients (61.70%) and very severe disease in 11 patients(23.40%). While Post op BCTSQ symptomatic part showed normality in 44 patients (93.61%),mild disease in 3 patients(6.39%) and moderate, severe and very severe disease were 00%. While post op BCTSQ functional part was normalin 45 patients (95.74%), mild in 2 patien...
Carpal Tunnel Syndrome. Part II: Effectiveness of Surgical Treatments—A Systematic Review
Archives of Physical Medicine and Rehabilitation, 2010
Objective: To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS). Data Sources: The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Study Selection: Two reviewers independently applied the inclusion criteria to select potential studies. Data Extraction: Two reviewers independently extracted the data and assessed the methodologic quality. Data Synthesis: A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or antiinflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of followup. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting. Conclusions: Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.