The Journal of Bone and Joint Surgery, Vol 75, Issue 9 1265-1275, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods
RA Brown, RH Gelberman, JG Seiler, SO Abrahamsson, AJ Weiland, JR Urbaniak, DA Schoenfeld and D Furcolo
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114.
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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