Original Communications: Nerve
Endoscopic versus open carpal tunnel release: A randomized trial,☆☆,*,**,

https://doi.org/10.1053/jhsu.2003.50080Get rights and content

Abstract

Purpose: This study compared the outcomes in patients assigned to either endoscopic carpal tunnel release (ECTR) or traditional open carpal tunnel release (OCTR). Methods: An unbalanced randomized clinical trial (91 endoscopic, 32 open) was conducted. Short-term and long-term outcomes were evaluated by a blinded assessor. The primary outcome measures were symptom severity measured on a self-report scale and nerve/vascular complications. Secondary outcomes included the McGill pain questionnaire, grip strength, pinch strength, sensory threshold (NK PSSD device, NK Biotechnical Corp, Minneapolis, MN), and time to return to work. Results: Both groups improved on all outcomes. No differences were observed in primary outcomes between the groups at either baseline or follow-up at 1 week, 6 weeks, or 12 weeks after surgery. No significant complications occurred in either group. Grip strength and pain were significantly better at 1 and 6 weeks in the endoscopic group although differences dissipated by 12 weeks. No significant differences occurred in other secondary outcomes. Long-term satisfaction was lower in the endoscopic group, attributable to a 5% rate of re-operation. Lower rates of endoscopic release have occurred at our center once these results were available to surgeons and patients. Conclusions: No substantive difference in benefit was shown for these 2 methods of carpal tunnel release. (J Hand Surg 2003;28A:475-480. Copyright © 2003 by the American Society for Surgery of the Hand.)

Section snippets

Study design

A randomized clinical trial comparing open and endoscopic procedures was conducted. Sample size calculations were performed to ensure 80% power to detect differences in the primary outcome measure, the Symptom Severity Scale.9 Patients were randomized in an unbalanced design with a 3:1 probability of receiving an endoscopic procedure. This design was chosen because of the controversy over complication rates for ECTR as compared with relatively stable and long-standing estimates for OCTR. Three

Results

No difference between the groups was observed in either of the primary outcomes at any of the observation points. No vascular or nerve complications occurred and Symptom Severity Scores improved equally well over time (Fig. 1).

. Scores from the Symptom Severity Scale for treatment groups showed no differences at any point in time.

A slight increase in symptoms was noted the first week after surgery that was attributed to postoperative pain and swelling but symptoms improved dramatically in both

Discussion

This study found that patients having ECTR had a transient benefit in grip and pain compared with patients who had a traditional open release but there were no differences evident by 3 months after surgery. Unlike some trials these short-term benefits did not translate into earlier return to work. Furthermore the 2 primary outcomes, carpal tunnel symptoms and complications, showed no differences between the groups at any point in time. In the absence of specific data to define the clinically

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

☆☆

Supported by the physicians of Ontario through the Physicians Services Incorporated Foundation.

*

This article won the prize for best scientific paper at the 2001 Annual Meeting of the American Society for Hand Therapists.

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Reprint requests: Joy C. MacDermid, PhD, Co-director, HULC Clinical Research Laboratory, Monsignor Roney Ambulant Care Centre, 930 Richmond St, London, Ontario, Canada N6A 3J4.

0363-5023/03/28A03-0019$30.00/0

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