Early Results of Conventional Versus Two-Portal Endoscopic Carpal Tunnel Release

The authors compare in a prospective, randomized study the early outcome of carpal tunnel release using either a conventional palmar open release ( n=40) or a two-portal endoscopic release ( n=56). Both groups were similar. No statistically significant differences were found regarding pain, disappearing of paraesthesiae or time to return to work. However, better recovery of grip strength was observed in the endoscopic group at 1 and 3 months. No surgical complications were observed in either group.

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The Results of Carpal Tunnel Release: Open Versus Endoscopic Technique

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90039-6 ◽

1994 ◽

Vol 19 (1) ◽

pp. 14-17 ◽

Cited By ~ 68

Author(s):

S. BANDE ◽

L. DE SMET ◽

G. FABRY

Keyword(s):

Patient Satisfaction ◽

Return To Work ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Endoscopic Technique ◽

Open Release ◽

Significant Difference ◽

Open Versus ◽

Portal Technique

We retrospectively compared two similar groups of patients who underwent either endoscopic decompression of the carpal tunnel (single portal technique, 44 patients) or open decompression (58 patients) during 1 year in our department. To find out whether there was any subjective difference between the results of the two techniques, we sent each patient a questionnaire and received a 95% response. No major complications occurred. Three endoscopic decompressions had to be abandoned, and open release was performed. We could not demonstrate any significant difference in relief of symptoms and return to work between the two groups. Patient satisfaction at 6 to 18 months follow-up was high with both techniques.

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ENDOSCOPIC CARPAL TUNNEL RELEASE FOR RECURRENT CARPAL TUNNEL SYNDROME AFTER PREVIOUS OPEN RELEASE

Hand Surgery ◽

10.1142/s0218810404002327 ◽

2004 ◽

Vol 09 (02) ◽

pp. 235-239 ◽

Cited By ~ 12

Author(s):

Lam Chuan Teoh ◽

Puay Ling Tan

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Open Release ◽

Endoscopic Carpal Tunnel Release ◽

Endoscopic Release ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release ◽

Surgical Release

Recurrent carpal tunnel syndrome from various causes has been shown to occur in up to 19% of patients. Endoscopic carpal tunnel release has been used to decompress the median nerve in carpal tunnel syndrome for many years. However, endoscopic release for recurrent carpal tunnel syndrome after previous surgical release has not been reported. Nine hands in six patients had recurrent carpal tunnel syndrome five to 20 years after previous open carpal tunnel release. All the cases were successfully treated with endoscopic release.

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Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release

Hand ◽

10.1177/1558944719861711 ◽

2019 ◽

pp. 155894471986171 ◽

Cited By ~ 2

Author(s):

Blair R. Peters ◽

Amanda M. Martin ◽

Brett F. Memauri ◽

Hardy W. Bock ◽

Robert B. Turner ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Resonance Imaging ◽

Open Release ◽

Endoscopic Carpal Tunnel Release ◽

Endoscopic Release ◽

Significant Difference

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study–confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon’s canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.

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ENDOSCOPIC CARPAL TUNNEL RELEASE AND CONGENITAL ANOMALIES OF THE MEDIAN NERVE

Hand Surgery ◽

10.1142/s0218810403001753 ◽

2003 ◽

Vol 08 (02) ◽

pp. 265-270 ◽

Cited By ~ 7

Author(s):

Andrew V. Cavallo ◽

Philip G. Slattery ◽

Richard J. Barton

Keyword(s):

Median Nerve ◽

Nerve Injury ◽

Carpal Tunnel ◽

Congenital Anomalies ◽

Carpal Tunnel Release ◽

Effective Means ◽

Open Release ◽

Endoscopic Carpal Tunnel Release ◽

Endoscopic Release

Endoscopic release has been shown to be a safe and effective means of carpal tunnel decompression. The surgeon needs to be aware of the variations in the anatomy of the median nerve in order to minimise the risk of nerve injury. In this series of 748 endoscopic carpal tunnel releases, six were found to have variations in the median nerve anatomy, in two patients conversion to open release was necessary.

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Early Mobilization Following Carpal Tunnel Release

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80057-9 ◽

1995 ◽

Vol 20 (2) ◽

pp. 228-230 ◽

Cited By ~ 75

Author(s):

A. C. COOK ◽

R. M. SZABO ◽

S. W. BIRKHOLZ ◽

E. F. KING

Keyword(s):

Return To Work ◽

Activities Of Daily Living ◽

Carpal Tunnel ◽

Daily Living ◽

Carpal Tunnel Release ◽

Randomized Study ◽

Early Mobilization ◽

Scar Tissue ◽

Pinch Strength ◽

Wrist Flexion

A prospective randomized study was undertaken of 50 consecutive patients undergoing surgery for idiopathic carpal tunnel syndrome to determine the value of splintage of the wrist following open carpal tunnel release. Patients were randomized to either be splinted for 2 weeks following surgery or to begin range-of-motion exercises on the first post-operative day. Subjects were evaluated at 2 weeks, 1 month, 3 months, and 6 months after surgery by motor and sensory testing, physical examination, and a questionnaire. Variables assessed included date of return to activities of daily living, dates of return to work at light duty and at full duty, pain level, grip strength, key pinch strength, and occurrence of complications. Patients who were splinted had significant delays in return to activities of daily living, return to work at light and full duty, and in recovery of grip and key pinch strength. Patients with splinted wrists experienced increased pain and scar tenderness in the first month after surgery; otherwise there was no difference between the groups in the incidence of complications. We conclude that splinting the wrist following open release of the flexor retinaculum is largely detrimental, although it may have a role in preventing the rare but significant complications of bowstringing of the tendons or entrapment of the median nerve in scar tissue. We recommend a home physiotherapy programme in which the wrist and fingers are exercised separately to avoid simultaneous finger and wrist flexion, which is the position most prone to cause bowstringing.

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Failed Endoscopic Carpal Tunnel Release

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1999.0243 ◽

1999 ◽

Vol 24 (4) ◽

pp. 465-467 ◽

Cited By ~ 46

Author(s):

S. E. VARITIMIDIS ◽

J. H. HERNDON ◽

D. G. SOTEREANOS

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Saphenous Vein Graft ◽

Carpal Tunnel Release ◽

Open Release ◽

Flexor Retinaculum ◽

Endoscopic Release ◽

Tunnel Syndrome ◽

Age Range

From 1994 to 1997, 22 patients (24 wrists) underwent open revision carpal tunnel release for persistent carpal tunnel syndrome after a primary endoscopic release. The age range was from 21 to 77 years. At the time of revision surgery, 22 wrists had an incomplete release of the flexor retinaculum and two patients had median nerve transection (one partial and one complete). One patient had release of Guyon’s canal and not the carpal tunnel. After the open revision carpal tunnel release, 20 patients returned to work with five patients returning to jobs of lighter duty. In addition, these 20 patients had significant improvement in symptoms. The remaining two patients had sustained a median nerve injury and did not return to work. One of these patients developed a painful neuroma in continuity of the median nerve which required vein wrapping with a saphenous vein graft. This study indicates that endoscopic release of the flexor retinaculum holds the same risks and complications as open release. Based on our study we believe that patients with persistent carpal tunnel syndrome after failed endoscopic flexor retinaculum release can be successfully treated with open release.

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Local Symptoms After open Carpal Tunnel Release

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80393-2 ◽

1997 ◽

Vol 22 (3) ◽

pp. 317-321 ◽

Cited By ~ 33

Author(s):

N. D. CITRON ◽

S. P. BENDALL

Keyword(s):

Randomized Trial ◽

Carpal Tunnel ◽

Lower Incidence ◽

Carpal Tunnel Release ◽

Open Release ◽

Endoscopic Release ◽

Postoperative Symptoms ◽

Open Carpal Tunnel Release

We report a randomized trial of two skin incisions for carpal tunnel decompression, namely a standard incision and an ulnar L incision. We looked particularly at the resolution of local symptoms namely pillar pain and scar sensitivity. There were 47 patients in the trial. No difference was found in pillar pain between the two incisions, but one had a lower incidence of scar sensitivity. These results give a baseline for comparison of local postoperative symptoms following open release with those following endoscopic release.

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211001715 ◽

2021 ◽

pp. 175319342110017

Author(s):

Saskia F. de Roo ◽

Philippe N. Sprangers ◽

Erik T. Walbeehm ◽

Brigitte van der Heijden

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Meta Analysis ◽

Surgical Techniques ◽

Open Release ◽

Flap Coverage ◽

Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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