Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 5/2013

01-05-2013 | Clinical Research

Endoscopic Carpal Tunnel Release Is Preferred Over Mini-open Despite Similar Outcome: A Randomized Trial

Authors: Ho Jung Kang, MD, PhD, Il Hyun Koh, MD, Tae Jin Lee, MD, Yun Rak Choi, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2013

Login to get access

Abstract

Background

The decision to perform endoscopic versus the mini-open carpal tunnel release technique is most likely left to surgeons rather than patients with idiopathic carpal tunnel syndrome.

Questions/purposes

We hypothesized that (1) at 3 months after surgery, the subjective outcomes of endoscopic release, performed on one hand, and mini-incision release, performed on the other, would not differ in patients with bilateral carpal tunnel syndrome; however, (2) each patient would likely prefer one technique over the other for specific reasons.

Methods

Fifty-two patients with bilateral carpal tunnel syndrome had one hand randomized to undergo endoscopic release and the other to undergo mini-incision release. Each patient was assessed with the Boston Carpal Tunnel Questionnaire (BCTQ) and DASH preoperatively and at each followup. Three months after surgery, the patients commented on which technique they preferred and completed a questionnaire regarding the reasons for not preferring the other technique.

Results

The mean BCTQ symptom/function score and DASH improved similarly in the endoscopic release group and the mini-incision release group. Thirty-four patients preferred endoscopic release and 13 preferred the mini-incision technique. Scar or pillar pain was the most commonly cited factor in not preferring either technique followed by postoperative pain for the open technique and transient worsening of symptoms for the endoscopic technique.

Conclusions

Despite similar improvements in BCTQ and DASH scores after endoscopic and open techniques at 3 months postoperatively, the majority of our patients preferred the endoscopic technique. The most concerning reason for not preferring the other technique was scar or pillar pain.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Atroshi I, Hofer M, Larsson GU, Ornstein E, Johnsson R, Ranstam J. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year followup of a randomized controlled trial. J Hand Surg Am. 2009;34:266–272.PubMedCrossRef Atroshi I, Hofer M, Larsson GU, Ornstein E, Johnsson R, Ranstam J. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year followup of a randomized controlled trial. J Hand Surg Am. 2009;34:266–272.PubMedCrossRef
2.
go back to reference Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473.PubMedCrossRef Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473.PubMedCrossRef
3.
go back to reference Bederman SS, Mahomed NN, Kreder HJ, McIsaac WJ, Coyte PC, Wright JG. In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery. Spine (Phila Pa 1976). 2003;35:108–115.CrossRef Bederman SS, Mahomed NN, Kreder HJ, McIsaac WJ, Coyte PC, Wright JG. In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery. Spine (Phila Pa 1976). 2003;35:108–115.CrossRef
4.
go back to reference Bhattacharya R, Birdsall PD, Finn P, Stothard J. A randomized controlled trial of knifelight and open carpal tunnel release. J Hand Surg Br. 2004;29:113–115.PubMedCrossRef Bhattacharya R, Birdsall PD, Finn P, Stothard J. A randomized controlled trial of knifelight and open carpal tunnel release. J Hand Surg Br. 2004;29:113–115.PubMedCrossRef
5.
go back to reference Bryant D, Bednarski E, Gafni A. Incorporating patient preferences into orthopaedic practice: should the orthopaedic encounter change? Injury. 2006;37:328–334.PubMedCrossRef Bryant D, Bednarski E, Gafni A. Incorporating patient preferences into orthopaedic practice: should the orthopaedic encounter change? Injury. 2006;37:328–334.PubMedCrossRef
6.
go back to reference Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini-incision blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am. 2005;30:493–499.PubMedCrossRef Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini-incision blind procedure versus limited open technique for carpal tunnel release: a 30-month follow-up study. J Hand Surg Am. 2005;30:493–499.PubMedCrossRef
7.
go back to reference Chung KC, Walters MR, Greenfield ML, Chernew ME. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg. 1998;102:1089–1099.PubMed Chung KC, Walters MR, Greenfield ML, Chernew ME. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg. 1998;102:1089–1099.PubMed
8.
go back to reference Cresswell TR, Heras-Palou C, Bradley MJ, Chamberlain ST, Hartley RH, Dias JJ, Burke FD. Long-term outcome after carpal tunnel decompression: a prospective randomised study of the Indiana Tome and a standard limited palmar incision. J Hand Surg Eur Vol. 2008;33:332–336.PubMed Cresswell TR, Heras-Palou C, Bradley MJ, Chamberlain ST, Hartley RH, Dias JJ, Burke FD. Long-term outcome after carpal tunnel decompression: a prospective randomised study of the Indiana Tome and a standard limited palmar incision. J Hand Surg Eur Vol. 2008;33:332–336.PubMed
9.
go back to reference Demirci S, Kutluhan S, Koyuncuoglu HR, Kerman M, Heybeli N, Akkuş S, Akhan G. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2002;22:33–37.PubMedCrossRef Demirci S, Kutluhan S, Koyuncuoglu HR, Kerman M, Heybeli N, Akkuş S, Akhan G. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2002;22:33–37.PubMedCrossRef
10.
go back to reference Ferdinand RD, MacLean JG. Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: a prospective, randomised, blinded assessment. J Bone Joint Surg Br. 2002;84:375–379.PubMedCrossRef Ferdinand RD, MacLean JG. Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: a prospective, randomised, blinded assessment. J Bone Joint Surg Br. 2002;84:375–379.PubMedCrossRef
11.
go back to reference Gerritsen AA, Uitdehaaq BM, van Geldere D, Scholten RJ, de Vet HC, Bouter LM. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg. 2001:88;1285–1295.PubMedCrossRef Gerritsen AA, Uitdehaaq BM, van Geldere D, Scholten RJ, de Vet HC, Bouter LM. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg. 2001:88;1285–1295.PubMedCrossRef
12.
go back to reference Gong HS, Baek GH, Oh JH, Lee YH, Jeon SH, Chung MS. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am. 2009;91:2130–2136.PubMedCrossRef Gong HS, Baek GH, Oh JH, Lee YH, Jeon SH, Chung MS. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am. 2009;91:2130–2136.PubMedCrossRef
13.
go back to reference Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.PubMedCrossRef Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.PubMedCrossRef
14.
go back to reference Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, Li-Tsang CW, Wong LK, Boet R. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074–2078.PubMedCrossRef Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, Li-Tsang CW, Wong LK, Boet R. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074–2078.PubMedCrossRef
15.
go back to reference Kharwadkar N, Naique S, Molitor PJ. Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release. J Hand Surg Br. 2005;30:92–95.PubMedCrossRef Kharwadkar N, Naique S, Molitor PJ. Prospective randomized trial comparing absorbable and non-absorbable sutures in open carpal tunnel release. J Hand Surg Br. 2005;30:92–95.PubMedCrossRef
16.
go back to reference Kim JK, Kim YK. Predictors of scar pain after open carpal tunnel release. J Hand Surg Am. 2011;36:1042–1046.PubMedCrossRef Kim JK, Kim YK. Predictors of scar pain after open carpal tunnel release. J Hand Surg Am. 2011;36:1042–1046.PubMedCrossRef
17.
go back to reference Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–1592.PubMed Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585–1592.PubMed
18.
go back to reference Ludlow KS, Merla JL, Cox JA, Hurst LN. Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther. 1997;10:277–282.PubMedCrossRef Ludlow KS, Merla JL, Cox JA, Hurst LN. Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther. 1997;10:277–282.PubMedCrossRef
19.
go back to reference Macdermid JC, Richards RS, Roth JH, Ross DC, King GJ. Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg Am. 2003;28:475–480.PubMedCrossRef Macdermid JC, Richards RS, Roth JH, Ross DC, King GJ. Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg Am. 2003;28:475–480.PubMedCrossRef
20.
go back to reference Mackenzie DJ, Hainer R, Wheatley MJ. Early recovery after endoscopic vs short-incision open carpal tunnel release. Ann Plast Surg. 2000;44:601–604.PubMedCrossRef Mackenzie DJ, Hainer R, Wheatley MJ. Early recovery after endoscopic vs short-incision open carpal tunnel release. Ann Plast Surg. 2000;44:601–604.PubMedCrossRef
21.
go back to reference Mattioli S, Baldasseroni A, Curti S, Cooke RM, Mandes A, Zanardi F, Farioli A, Buiatti E, Campo G, Violante FS. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med. 2009;66:299–304.PubMedCrossRef Mattioli S, Baldasseroni A, Curti S, Cooke RM, Mandes A, Zanardi F, Farioli A, Buiatti E, Campo G, Violante FS. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med. 2009;66:299–304.PubMedCrossRef
22.
go back to reference Rab M, Grunbeck M, Beck H, Haslik W, Schrögendorfer KF, Schiefer HP, Mittlböck M, Frey M. Intra-individual comparison between open and 2-portal endoscopic release in clinically matched bilateral carpal syndrome. J Plast Reconstr Aesthet Surg. 2006;59:730–736.PubMedCrossRef Rab M, Grunbeck M, Beck H, Haslik W, Schrögendorfer KF, Schiefer HP, Mittlböck M, Frey M. Intra-individual comparison between open and 2-portal endoscopic release in clinically matched bilateral carpal syndrome. J Plast Reconstr Aesthet Surg. 2006;59:730–736.PubMedCrossRef
23.
go back to reference Ruch DS, Poehling GG. Endoscopic carpal tunnel release: the Agee technique. Hand Clin. 1996;12:299–303.PubMed Ruch DS, Poehling GG. Endoscopic carpal tunnel release: the Agee technique. Hand Clin. 1996;12:299–303.PubMed
24.
go back to reference Saw NL, Jones S, Shepstone L, Meyer M, Chapman PG, Logan AM. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg Br. 2003;28:444–449.PubMedCrossRef Saw NL, Jones S, Shepstone L, Meyer M, Chapman PG, Logan AM. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg Br. 2003;28:444–449.PubMedCrossRef
25.
go back to reference Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1997;20:1477–1486.PubMedCrossRef Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. 1997;20:1477–1486.PubMedCrossRef
26.
go back to reference Thoma A, Veltri K, Haines T, Duku E. A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg. 2004;114:1137–1346.PubMed Thoma A, Veltri K, Haines T, Duku E. A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg. 2004;114:1137–1346.PubMed
27.
go back to reference Trousdale RT, McGrory BJ, Berry DJ, Becker MW, Harmsen WS. Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc. 1999;74:978–982.PubMed Trousdale RT, McGrory BJ, Berry DJ, Becker MW, Harmsen WS. Patients’ concerns prior to undergoing total hip and total knee arthroplasty. Mayo Clin Proc. 1999;74:978–982.PubMed
28.
go back to reference Ucan H, Yagci I, Yilmaz L, Yagmurlu F, Keskin D, Bodur H. Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2006;27:45–51.PubMedCrossRef Ucan H, Yagci I, Yilmaz L, Yagmurlu F, Keskin D, Bodur H. Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2006;27:45–51.PubMedCrossRef
29.
go back to reference Wong KC, Hung LK, Ho PC, Wong JM. Carpal tunnel release: a prospective, randomised study of endoscopic versus limited-open methods. J Bone Joint Surg Br. 2003;85:863–868.PubMed Wong KC, Hung LK, Ho PC, Wong JM. Carpal tunnel release: a prospective, randomised study of endoscopic versus limited-open methods. J Bone Joint Surg Br. 2003;85:863–868.PubMed
Metadata
Title
Endoscopic Carpal Tunnel Release Is Preferred Over Mini-open Despite Similar Outcome: A Randomized Trial
Authors
Ho Jung Kang, MD, PhD
Il Hyun Koh, MD
Tae Jin Lee, MD
Yun Rak Choi, MD, PhD
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 5/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2666-z

Other articles of this Issue 5/2013

Clinical Orthopaedics and Related Research® 5/2013 Go to the issue

Symposium: Special Considerations for TKA in Asian Patients

What Are the Causes of Revision Total Knee Arthroplasty in Japan?