Article
Assessment of surgical treatment for carpal tunnel syndrome. Endoscopic vs Open release
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Authors
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Jhon Fredy Castañeda
- Universidad Nacional de Colombia, Bogota, Colombia
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Diego Fernando Rincon
- Universidad Industrial de Santander, Floridablanca, Colombia
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Alvaro Antonio Kafury
- Centro Medico Imbanaco, Floridablanca, Colombia
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Juliana Andrea Rojas Neira
- Centro Medico Imbanaco, Floridablanca, Colombia
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: To compare the clinical and functional results of surgical treatment of carpal tunnel syndrome between endoscopic and open techniques release
Methods: Cases series study that included patients who underwent either open or endoscopic release. The open technique was performed using the conventional palmar approach and endoscopy was carried out using Agee's one-portal technique. Immediate complications and progress within the first month after surgery were assessed. Long-term assessment was conducted. This included assessment of functionality (DASH), strength (level II JAMAR dynamometer) and level of pain (VAS). Additionally, satisfaction with the outcome (improvement of symptoms) and procedure (recovery process) was evaluated
Results: 408 procedures (open 184, endoscopic 224) performed in 331 patients with a mean age of 56.3 ± 13.5 years were included, 85.5% being women. Axonal injury (7.1%) and thenar atrophy (24.3%) were similar between treatment groups (p>0.05). During the open procedure 22.8% of cases needed associate surgical procedures as compared with 1.8% in the endoscopic group (p<0.05) The most common associate procedures were flexor tenosynovectomy and trapeziectomy with tenosuspension, among other. No statistically significant differences were observed between either open or endoscopic techniques in relation to intraoperative complications or infection. Adequate improvement of symptoms was observed in 98.3% of patients and need of physical therapy was more common for the open technique. A higher incidence of pillar pain, wound pain and scar adhesions within the first month was found for the open technique (p<0.05).
A total of 78 patients was contacted to evaluate long-term outcomes, with a mean follow-up of 28 months. The DASH scale showed an average of 3.2 points. No differences in symptom relapse or long-term pain were observed (p<0.05) Grip and pinch strength was more than 80% on the non-compromised side in the majority of patients.
Patients who underwent the endoscopic technique showed greater satisfaction in relation to the surgical procedure and initial recovery (open 70%, endoscopic 98%, p< 0.05) but there were no differences regarding satisfaction with respect to the final outcome of either technique (p >0.05).
Conclusions: Although long-term clinical and functional outcomes were similar, the endoscopic technique showed faster recovery, less complications within the first month, reduced need of physical therapy during recovery and greater level of patient satisfaction.
