The Journal of Bone and Joint Surgery (American) 84:1107-1115 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Single-Portal Endoscopic Carpal Tunnel Release Compared with Open Release
A Prospective, Randomized Trial
Thomas E. Trumble, MD,
Edward Diao, MD,
Reid A. Abrams, MD and
Mary M. Gilbert-Anderson, MA
Investigation performed at the Department of Orthopaedics, University
of Washington Medical Center, Seattle, Washington; the Department
of Orthopaedic Surgery, University of California, San Francisco,
California; and the Department of Orthopaedics, University of California,
San Diego, California
Thomas E. Trumble, MD
Mary M. Gilbert-Anderson, MA
Department of Orthopaedics, Box 356500, 1959 N.E. Pacific Street,
University of Washington Medical Center, Seattle, WA 98195. E-mail
address for T.E. Trumble: trumble{at}u.washington.edu
Edward Diao, MD
Department of Orthopaedic Surgery, University of California, San
Francisco, 500 Parnassus Avenue, MU-320-West, San Francisco, CA
94143
Reid A. Abrams, MD
Department of Orthopaedics, University of California, San Diego,
350 Dickinson Street, Mailcode 8894, San Diego, CA 92103
In support of their research or preparation of this manuscript, one
or more of the authors received grants or outside funding from the
Orthopaedic Research and Education Foundation, The American Society
for Surgery of the Hand, and the Boeing Foundation. None of the
authors received payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other charitable
or nonprofit organization with which the authors are affiliated
or associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our quarterly CD-ROM (call
our subscription department, at 781-449-9780, to order the CD-ROM).
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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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