Studies Carried Out To Explore The Outcomes Of Endoscopic And Open Carpal Tunnel Release

2411 words - 10 pages

Several studies have been carried out to explore the outcomes of endoscopic and open carpal tunnel release. A randomised controlled trial by Atroshi et al to compare endoscopic and open carpal tunnel release showed that less postoperative pain are associated with endoscopic surgery compared to open release9. This study involved 128 patients with confirmed idiopathic CTS diagnosed clinically and electrophysiologically9. Patients who underwent endoscopic released had less post operative pain in the scar and proximal hand and also less activity limitations compared to the other group (53% and 82% respectively)9. In both groups, the hand sensation and strength improved by 3 months9. Additionally, there were no differences in the severity of CTS symptoms post- operatively9. 71% of patients with endoscopic release and 72% of patients with open release reported absence of tingling and numbness after 3 months9. In terms of length work absence, there was also no significant difference between these two methods9. However, two patients with endoscopic release had worsening of symptoms and underwent open CTS release 9 months and 5 months respectively after the intial procedure9. Only 1 patient with open CTS experienced worsening of symptoms and underwent a repeat open release 12 months after the first procedure9. One of the disadvantages of this study is that the post operative pain is rated by patients and there may be some bias associated with this as patient pain tolerance is subjective and may differ9. Additionally, patients were not blinded as blinding patient throughout surgery and follow up is not possible, thus this creates observed differences and biasness9.
A randomized study by Trumble et al to compare endoscopic and open carpal tunnel release showed that single endoscopic carpal tunnel release is a safe and effective method as good clinical outcomes and patients’ satisfactions were achieved through this method10. This study involved 192 hands from 147 patients10. Overall, patients treated with endoscopic release had less carpal tunnel symptoms severity, better functional status and higher satisfactory scores in the first three months compared to open release10. Additionally, better grip strength, pinch strength, and hand dexterity were achieved via endoscopic method10. Patients who underwent endoscopic release return to work earlier compared to patients underwent surgical release (18 days in endoscopic release and 38 in surgical release)10. in contrast, more pain and tenderness on the scar is associated with open surgery10. This study also concluded that there are no significant differences in the rate of post operative complications between these two groups10.
One of the drawbacks of this study is that, even though this study was described as randomised, patients who presented with CTS on the other hand were re- entered to the study for the same procedure without randomisation9. As in this study the two hands were analysed separately,...

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