Analysis of Reporting Return to Work in Studies Comparing Open with Endoscopic Carpal Tunnel Release: A Review of Randomized Controlled Trials

Ayeni, Olubimpe; Thoma, Achilleas; Haines, Ted; Sprague, Sheila

doi:10.1177/229255030501300403

Cited by 8 publications

(9 citation statements)

References 32 publications

(106 reference statements)

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“…32,33 In addition, whereas measures such as grip strength and return to work status ideally reflect function and recovery, return to work is an imperfect measure of recovery because it is highly dependent on factors unrelated to nerve recovery itself, such as patient motivation, occupation, and surgeon expectations. 6,7 Finally, the follow-up of 6 weeks after surgery is short; however, Atroshi et al 1 showed that improvement in symptoms and functional status can be expected in the first 6 weeks, as supported by the statistically significant differences in CTSAQ scores observed here.…”

Section: Discussionsupporting

confidence: 70%

“…21,30,31 Although evidence has been mixed, ECTR demonstrated functionally significant improvement in grip strength and faster return to work (8 days sooner, on average) in various reports. 6,7 Patients who underwent ECTR had a decrease in median nerve CSA (e1.9 mm 2 ), in contrast to an increase in CSA (þ0.6 mm 2 ) in the MOCTR group. Both groups demonstrated a statistical improvement in both SSS and FSS; however, the improvement in FSS in the MOCTR group lacked a clinically important change when using a change of 1.04 as a threshold.…”

Section: Discussionmentioning

confidence: 95%

“…Proposed advantages of endoscopic techniques include smaller incisions made away from the middle of the palm and division of the transverse carpal ligament (TCL) from within the carpal tunnel, leaving superficial structures intact, resulting in less pain, less scarring, and shorter recovery times. 3 , 4 , 5 , 6 , 7 …”

mentioning

confidence: 99%

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A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release

Smith

Hirsch

Osei-Hwedieh

et al. 2020

Journal of Hand Surgery Global Online

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The purpose of this study was to determine whether there is a difference in the change in crosssectional area (CSA) of the median nerve in patients undergoing carpal tunnel release (CTR) based on surgical technique and whether this change is associated with changes in patient-reported outcomes evaluated using the Carpal Tunnel Syndrome Assessment Questionnaire. Methods: Individuals with carpal tunnel syndrome were evaluated with ultrasound and the CTSAQ before and 6 weeks after surgery. Patients were eligible for inclusion if they underwent either a miniopen CTR (MOCTR) or endoscopic CTR (ECTR). A single surgeon performed all surgeries. Changes in median nerve CSA, Carpal Tunnel Syndrome Assessment Questionnaire scores, and their associated surgical technique (MOCTR vs ECTR) were analyzed. Results: A total of 77 patients were enrolled, 13 of whom were lost to follow-up, which left 64 for analysis. Of those, 42 patients underwent ECTR and 22 MOCTR. Mean age was 55 years; there were 52 women and 12 men. Mean changes in CSA for endoscopic and mini-open techniques from before to 6 weeks after surgery were e1.9 mm 2 (95% confidence interval [CI], e1.1 to e2.7) and þ0.6 mm 2 (95% CI, e1.6 to 0.4), respectively. Mean Symptom Severity Scores improved after endoscopic and mini-open release by 1.7 (95% CI, 1.4e2.1) and 1.5 (95% CI, 1.2e1.9), respectively. Mean Functional Status Scores improved after endoscopic and mini-open release by 1.2 (95% CI, 0.9e1.9) and 0.7 (95% CI, 0.03e1.3), respectively. Conclusions: Patients undergoing ECTR demonstrated decreased median nerve CSA, whereas those undergoing MOCTR demonstrated increased median nerve CSA at 6 weeks. All patients undergoing surgical intervention demonstrated improvement in both Symptom Severity Scores and Functional Status Scores after surgery. Whereas both techniques successfully improve patient outcome scores, an increase in CSA after MOCTR may be seen in the initial postoperative period, potentially contributing to a slower shortterm improvement in outcome in functional scores compared with ECTR. Type of study/level of evidence: Therapeutic IV.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release

Smith

Hirsch

Osei-Hwedieh

et al. 2020

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

show abstract

“…However, conventional open carpal tunnel release surgery can be associated with increased surgical trauma that results in longer postoperative recovery times. A further postoperative complication of conventional release surgery is the formation of scar tissue on the palm of the hand and scar tenderness that can be associated with the development of a neuroma in the palmar cutaneous nerve branch, which can affect the postoperative quality of life [9].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center

Teng

Yuan

et al. 2019

Med Sci Monit

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Background This study aimed to compare the efficacy and safety of wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery for the treatment of carpal tunnel syndrome. Material/Methods Patients with carpal tunnel syndrome (n=111) were treated with wrist arthroscopy (n=33), small incision surgery (n=40), and conventional open carpal tunnel release surgery (n=38). Incision length, duration of surgery, degree of intraoperative bleeding, recovery time, and findings at postoperative follow-up at one month, three months, and six months after surgery were recorded. Assessment included the two-point discrimination test, the grip and pinch strength test, the visual analog scale (VAS) score for pain, the Levine questionnaire, and Kelly’s therapeutic evaluation. Results Incision length, duration of surgery, intraoperative bleeding, and recovery time were significantly reduced in the wrist arthroscopy group and the small incision surgery group compared with the conventional surgery group (p<0.05). There were no significant differences in the two-point discrimination or grip and pinch strength test (p>0.05). Postoperatively, at one month, the VAS score, Levine score, and Kelly’s therapeutic evaluation in the wrist arthroscopy group and the small incision surgery group were significantly lower compared with the conventional surgery group (p<0.05). Scar length and scar tenderness in the conventional surgery group were significantly increased compared with the wrist arthroscopy group and the small incision surgery group (p<0.05). Conclusions Wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery were effective for the treatment of carpal tunnel syndrome, but conventional surgery resulted in more postoperative complications.

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“…Inconsistencies in the definition and measurement of time to RTW in CTR settings have been previously discussed (73). The authors called for standardized assessment of RTW, measured in days, and including information on type of work, insurance status and rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Sickness absence after carpal tunnel release: a systematic review of the literature

Newington¹,

Stevens²,

Warwick³

et al. 2018

Scand J Work Environ Health

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Objectives The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns. Methods A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range. Results A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4-168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7-41), compared with 39 days for manual work (range 18-101). Median time to return to modified or full duties was 23 days (ranges 12-50 and 17-64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data. Conclusions This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

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Analysis of Reporting Return to Work in Studies Comparing Open with Endoscopic Carpal Tunnel Release: A Review of Randomized Controlled Trials

Cited by 8 publications

References 32 publications

A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release

A Comparison of Changes in Median Nerve Cross-sectional Area Between Endoscopic and Mini-Open Carpal Tunnel Release

Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center

Sickness absence after carpal tunnel release: a systematic review of the literature

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