This is a multicenter, prospective, randomized study comparing single-portal endoscopic carpal tunnel release (ECTR) with open carpal tunnel release (OCTR). 192 hands in 147 patients were treated by three surgeons at three different institutions. All patients had symptoms, signs and electrodiagnostic tests confirming CTS. The average age was 56 years (range, 24-74) and the duration of symptoms prior to surgery was 32 months (range, 4 months – 11 years). There were 44 patients (58 hands) with an approved worker’s compensation claim in the ECTR group and 40 patients (51 hands) in the OCTR group. An independent observer, blinded to the type of procedure used, evaluated the patients. A CTS Symptom Severity Score and Functional Status Score were calculated from a pre- and post-operative questionnaire. Routine postoperative evaluations were performed at multiple intervals over one year following the operative procedure. During the first three months, patients treated with ECTR had significantly better Symptom Severity Scores, Functional Status Scores, subjective satisfaction scores, grip strength, pinch strength and dexterity. There was less scar sensitivity following ECTR and patients returned to work faster following ECTR (median, 18 days) than OCTR (median, 38 days). There was no significant difference in cost or complications with no neurovascular injuries, although one OCTR patient required a revision because of persistent symptoms and two patients developed RSD in the OCTR group.
This study documents that ECTR not only relieves symptoms as well as OCTR, but it may more quickly improve patient’s symptoms, satisfaction, function and return to work. Previous studies have provided conflicting data regarding the benefits of ECTR in worker’s compensation patients. This paper gives further support to the benefits of ECTR in this population. Both ECTR and OCTR were found to be equally safe with similar one-year follow-up data indicating only an early benefit of ECTR. The endoscopic technique was not associated with greater surgical morbidity in this series as has been reported in some prior series. However, this report involves three surgeons, all comfortable with the endoscopic technique.
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