Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique

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Abstract

Objective:

To evaluate the postoperative results of patients with carpal tunnel syndrome by the endoscopic release technique with single portal.

Methods:

78 patients (80 wrists) were evaluated preoperatively and postoperatively at 1, 3 and 6 months by the Boston questionnaire, the visual analogue scale (VAS) for pain, monofilament test sensitivity, grip strength, lateral pinch, pulp to pulp pinch and tripod pinch.

Results:

Statistical analysis was significant (p <0.05) in the progressive decline of pain and improved function (Boston) during follow-up. The sensitivity significantly improved comparing the data pre and postoperatively. The grip strength, lateral pinch, pulp to pulp pinch and tripod pinch decreased in the first month after surgery, returning to preoperative values around the third month postoperatively.

Conclusion:

The technique proved to be safe and effective in improving pain, function, and return sensitivity and strength. Level of Evidence II, Prospective study

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Most cited references 61

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Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.

D Furcolo, R Gelberman, Kelly Seiler … (1993)

To define the role of two-portal endoscopic carpal-tunnel release as a method for the treatment of compression of the median nerve at the wrist, a prospective, randomized, multicenter study was performed on 169 hands in 145 patients. Either open or endoscopic carpal-tunnel release was performed in all of the patients who had clinical signs and symptoms consistent with carpal tunnel syndrome, had not responded to or had refused non-operative management, and had had electrodiagnostic studies consistent with carpal tunnel syndrome. Follow-up evaluations were performed at twenty-one, forty-two, and eighty-four days. At the end of the follow-up period, both the open and endoscopic methods had resulted in high levels of achievement of the primary outcomes (relief of pain and paresthesias). The numbness and paresthesias were relieved in eighty (98 per cent) of eighty-two hands in the open-release group compared with seventy-seven (99 per cent) of seventy-eight hands in the endoscopic-release group. This parameter was not recorded for three hands in the open-release group or six hands in the endoscopic-release group. The satisfaction of the patients with the procedure, graded on a scale of 0 to 100 per cent, averaged 84 per cent in the open-release group compared with 89 per cent in the group that had had endoscopic release. We found no significant differences between the two groups with regard to the secondary quantitative-outcome measurements, including two-point discrimination, postoperative interstitial-pressure data for the carpal canal, Semmes-Weinstein monofilament testing, and motor strength. The open technique resulted in more tenderness of the scar than did the endoscopic method. Thirty-two (39 per cent) of eighty-two hands in the open-release group and fifty (64 per cent) of seventy-eight hands in the endoscopic-release group were not tender at eighty-four days. This parameter was not recorded for three hands in the open-release group and six hands in the endoscopic-release group. The open method also resulted in a longer interval until the patient could return to work (median, twenty-eight days, compared with fourteen days for the open-release and endoscopic-release groups). Four complications occurred in the endoscopic carpal-tunnel release group: one partial transection of the superficial palmar arch, one digital-nerve contusion, one ulnar-nerve neuropraxia, and one wound hematoma.(ABSTRACT TRUNCATED AT 400 WORDS)

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Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.

Edward Diao, Suzanne Abrams, Thomas Trumble … (2002)

Carpal tunnel syndrome is a common condition causing hand pain and numbness. Endoscopic carpal tunnel release has been demonstrated to reduce recovery time, although previous studies have raised concerns about an increased rate of complications. The purpose of this prospective, randomized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release. A prospective, randomized, multicenter center study was performed on 192 hands in 147 patients. The open method was performed in ninety-five hands in seventy-two patients, and the endoscopic method was performed in ninety-seven hands in seventy-five patients. All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to, or had refused, nonoperative management. Follow-up evaluations with use of validated outcome instruments and quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at two, four, eight, twelve, twenty-six, and fifty-two weeks after the surgery. Complications were identified. The cost of the procedures and the time until return to work were recorded and compared between the groups. During the first three months after surgery, the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores, better Carpal Tunnel Syndrome Functional Status Scores, and better subjective satisfaction scores. During the first three months after surgery, they also had significantly (p < 0.05) greater grip strength, pinch strength, and hand dexterity. The open technique resulted in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work (median, thirty-eight days compared with eighteen days after the endoscopic release). No technical problems with respect to nerve, tendon, or artery injuries were noted in either group. There was no significant difference in the rate of complications or the cost of surgery between the two groups. Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome.

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Carpal tunnel syndrome.

Kyle Bickel (2010)

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the upper extremity. The condition is responsible for substantial annual costs to society, both in terms of lost productivity and the costs of treatment. Accurate diagnostic criteria, the selection of treatment strategies based on high-level evidence, and outcomes data have been inconsistent despite the prevalence of the condition. The increased awareness of the need for evidence-based practice guidelines has, however, yielded important data to guide treatment of CTS. Evidence-based guidelines for diagnosis and treatment have been developed and should direct the treatment of CTS. Copyright 2010. Published by Elsevier Inc.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Ortop Bras

Journal ID (iso-abbrev): Acta Ortop Bras

Journal ID (publisher-id): aob

Title: Acta Ortopedica Brasileira

Publisher: Sociedade Brasileira de Ortopedia e Traumatologia

ISSN (Print): 1413-7852

ISSN (Electronic): 1809-4406

Publication date (Print): 2014

Volume: 22

Issue: 1

Pages: 29-33

Affiliations

[1 ]Universidade Federal de São Paulo, São Paulo, SP, Brazil, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil

Author notes

Correspondence: Rua Borges Lagoa, 786, Vila Clementino, São Paulo, SP, Brazil. 040036-032. aldookamura@ 123456gmail.com

All the authors declare that there is no potential conflict of interest referring to this article.

Article

DOI: 10.1590/S1413-78522014000100005

PMC ID: 3952868

PubMed ID: 24644417

SO-VID: 8bfe6423-534b-4962-8307-4a2a73d659c7

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 18 September 2013

Date accepted : 16 October 2013

Page count

Figures: 9, Tables: 4, References: 20, Pages: 5

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Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique

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Abstract

Objective:

Methods:

Results:

Conclusion:

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Most cited references 61

Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.

Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.

Carpal tunnel syndrome.

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