RESUMO
Carpal tunnel Syndrome is the most common compression neuropathy of the upper extremity. Open carpal tunnel release [OCTR] with longitudinal incision reaching or crossing the wrist crease has been the golden standard of surgical treatment of carpal tunnel syndrome. Many reports indicated that the endoscopic carpal tunnel release [ECTR] techniques are associated with reducing postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. We conducted a randomised controlled trail to evaluate endoscopic 2-portal carpal tunnel release [ECTR] technique against the traditional open carpal tunnel release [OCTR]. One hundred and twenty two patients who were diagnosed to have carpal tunnel syndrome were randonised into 2 groups. In the trail ECTR group, there were 18 males [29%] and 44 females [71%]; their mean age was 44.6 years while the control OCTR group there were 18 males [30%] and 42 females [70%]; their mean age was 45.9 years. Patients were evaluated at baseline, 1,2,6 and 12 weeks and at 1 year after surgery for symptomatic relief by the Symptom Severity Scale[9] and incidence of serious complications [vascular or nerve injury] as well as McGill pain questionnaire[10], interval between the operation and return to their daily activities and work, scar tenderness and pillar pain, and grip strength which was assessed by a Jamar dynamometer as well as overall patient satisfaction. There was no significant difference in the Symptom Severity Score between both groups. However, there was one significant complication [laceration of a digital nerve] in the ECTR group while there was none in the OCTR group. McG ill pain score and grip strength were found to be significantly better in the ECTR group at 1, 2 and 6 weeks but almost identical at 12 weeks however scar tenderness and pillar pain was better in ECTR group at 12 weeks. The interval between surgery and return to usual daily activities and work was significantly less [P value < 0.01] in the endoscopic group than OCTR group. ECTR is associated with less pain and better function in the early postoperative period reflected by earlier return to usual daily activities and work as well as less scar tenderness and pillar pain. However these benefits may be outweighed not only with the higher expense of additional operative equipment and longer operating time but with a higher re-operation rate as well as a higher complication rate