Endoscopic Carpal Tunnel Release: A Review of 753 Cases in 486 Patients

Author(s): Schmelzer RE, Della Rocca GJ, Caplin DA

Source: Plastic & Reconstructive Surg 117: 177-185, 2006.

Summary:

his is a retrospective review of 753 endoscopic carpal tunnel releases in 486 patients performed by a single surgeon over a 13 year period.  The authors were interested in evaluating patient outcomes with respect to symptom relief, complications, and return of function, including return to work data.  All cases were evaluated for preoperative demographics, including work status, worker's compensation status, and co-morbidities.  Preoperative symptoms were noted, as well as any prior treatment, including prior carpal tunnel release.  470/472 patients complained of preoperative numbness and/or tingling, the vast majority with nocturnal awakening, and 347 patients complained of weakness preoperatively.  472/486 patients had undergone preoperative nerve conduction testing.  9/472 patients had negative studies but had a clinical diagnosis of CTS.  25/486 patients had prior CTR, 7 endoscopic and 18 open.  Follow-up evaluation was performed at a single hand therapy clinic independent of the operating surgeon's practice.  Results showed that all patients reported significant or complete relief of preoperative symptoms.  There was no statistically significant difference in the return to work time of worker's compensation versus non-worker's compensation patients.  Mean return to light duty was 20 days for both groups, full duty by 42 days for both groups.  90% returned to their original occupation.  Complications occurred in 1% of the group.  There were no major nerve, tendon, or vascular injuries noted.  87 patients (12%) reported scar tenderness or hypersensitivity.  They were all worker's compensation patients.  The 18 patients who had previously undergone open CTR and had secondary ECTR for recurrence all reported better satisfaction with ECTR over their experience with open CTR.

The authors have performed a comprehensive retrospective review of their experience with ECTR over a 13 year period.  Their data suggests that ECTR is safe and effective.  There was only one patient who required revision at one year after ECTR.  Open CTR subsequently performed in that patient revealed dense perineural fibrosis and was successful.  There were no apparent cases of incomplete release of the median nerve and persistent CTS.  The authors report a 1% complication rate, yet report a 12% rate of persistent scar tenderness at final evaluation.  This is confounding, in that one of their major indications for preferring ECTR over open is the minimization of this "complication" of open CTR postoperatively.  Because this is not a prospective, randomized trial, it is not possible to make any real conclusions about the rate of persistent scar tenderness in ECTR versus open CTR.  Therefore, although the data do show that in this setting ECTR is safe and effective, it does not adequately resolve the issue of postoperative scar morbidity (tenderness) in ECTR versus open CTR, which has traditionally been one of the primary areas of interest and important differentiation between the two techniques.

 

Carpal, Tunnnel, Release, Open, Endoscopic


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