Single-portal endoscopic versus open carpal tunnel release

ABSTRACT

Open release of the transverse carpal ligament [TCL] has been the gold standard surgical treatment for patients with carpal tunnel syndrome for the past several decades. However, significant concerns are the transient post-operative [pillar pain] scar tenderness and the length of recovery time. There has been widespread misunderstanding and confusion regarding endoscopic carpal tunnel release [ECTR] owing to different techniques with different complications and efficacy being viewed as one technique. This prospective randomized study was carried out to compare the single-portal ECTR and open carpal tunnel release [OCTR]. Between May 2006 to May 2007 Thirty-one patients with 60 wrists clinically diagnosed and electrophysiologically confirmed idiopathic CTS, and nonresponded to non-operative treatment were assigned to this study. Singleportal ECTR was performed in 16 patients with 30 wrist [14 bilateral CTS patients and 2 cases with right side CTS] and OCTR was performed in 30 wrists [15 bilateral CTS patients]. All cases were available for follow-up at 3 weeks, 3 and 6 months post-operatively. Outcome measures were evaluated such as CTS symptoms improvement, time needed to resume activities of daily living [ADL] and return to work and complications. Early onset of CTS symptoms relief was prevalent in single-portal ECTR group [66.5% within 3 days]. During the first three months post-operatively, patients sustained to the single-portal ECTR procedure were better symptomatically and functionally. Local wound problems in terms of painful scar or palm was reported by 10 wrists [33%] in the OCTR group, whereas non in the single-portal ECTR group, occasional pain with ADL reported in 3 wrists [10%] of the OCTR group. The average time to return to work was appreciably less in the single-portal ECTR [12 days] compared to 25 days in the OCTR group. No significant difference was observed between the two groups as regard to symptoms improvement, electrophysiological studies and complications at the end of six months. In conclusion, Singleportal ECTR is a safe and effective treatment of CTS, was associated with less post-operative pain, more quickly good clinical outcomes and patient satisfaction than OCTR. Hence the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain