Sleep disturbance and response to surgical decompression in patients with carpal tunnel syndrome: a prospective randomized pilot comparison of open versus endoscopic release.

BACKGROUND: Sleep disturbance is a common complaint of patients with carpal tunnel syndrome (CTS). While carpal tunnel release (CTR) surgery has been shown to relieve subjective sleep-related complaints, data is lacking on the global effect on sleep using validated sleep measures. Additionally, it is not known if open (OCTR) or endoscopic release (ECTR) produce differing degrees of sleep-symptom relief. METHODS: Sixty patients were randomly allocated to undergo either OCTR (n=30) or ECTR (n=30) surgery. Forty-three (71.7%) of the patients were female, and mean age of all patients was 49.4 years (range, 35-78). Prior to surgery, patients were administered three baseline self-reported outcome measures: the Pittsburgh Sleep Quality Index (PQSI), the Insomnia Severity Scale (ISI) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey, which were subsequently administered at three postoperative time points: 1-2 weeks, 4-6 weeks and 6-12 months. RESULTS: All 60 patients experienced significant improvements in the three outcome scores by their first postoperative visit compared to preoperatively. ECTR provided superior improvement to OCTR at the first postoperative visit for ISI (P=0.006) and PSQI (P=0.016), and at the second visit for PSQI (P=0.0038). There were no significant differences between the two groups for the QuickDASH at any time points, or for the ISI/PSQI at the final follow-up. CONCLUSION: Endoscopic and open CTR both improve sleep symptoms postoperatively in the short-term which is sustained for 6-12 months, although endoscopic CTR does so more rapidly.

Mini-open versus extended open release for severe carpal tunnel syndrome.

BACKGROUND: This study aims to compare surgical outcomes of severe carpal tunnel syndrome (CTS) treated with mini-incision versus extensile release. METHODS: The method employed in this study was a retrospective review of patients with severe CTS, defined by electrophysiologic studies showing non-recordable distal sensory latency of the median nerve. Patients underwent either a mini-incision (2 cm) release of the transverse carpal ligament (group 1) or extensile release proximal to the wrist flexion crease (group 2). Exclusion criteria included prior carpal tunnel release, use of muscle flap, multiple concurrent procedures, or a prior diagnosis of peripheral neuropathy. Group 1 included 70 wrists (40 females, 30 males). Group 2 included 64 wrists (35 females, 29 males). Reported outcomes included pre- and post-operative grip strength as well as Boston Carpal Tunnel Questionnaires (BCTQ). RESULTS: Patients in group 1 had a 22.6 % increase in grip strength postoperatively (4.5 months ± 5.0), while patients in group 2 had a 59.3 % increase (10.0 months ± 6.9). BCTQ surveys from group 1 (n = 46) demonstrated a symptom severity score of 12.93 and functional status score of 9.39 at an average follow-up of 41.9 ± 10.6 months. Group 2 (n = 42) surveys demonstrated averages of 12.88 and 9.10 at 43.1 ± 11.6 months. One patient in the mini-incision cohort required revision surgery after 2 years, while no patient in the extended release cohort underwent revision. CONCLUSION: No significant differences between the two procedures with regard to patient-rated symptom severity or functional status outcomes were found. Both techniques were demonstrated to be effective treatment options for severe CTS.