Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials

Li, Yueying; Luo, Wenqi; Wu, Guangzhi; Cui, Shusen; Zhang, Zhan; Gu, Xiaossong

doi:10.1186/s12891-020-03306-1

Cited by 81 publications

(89 citation statements)

References 62 publications

(91 reference statements)

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“…Endoscopic CTR has been associated with earlier return to work than open CTR, 32 however, it was not possible to assess this in the current study. At present, endoscopic CTR is not routinely performed in the UK.…”

Section: Discussionmentioning

confidence: 77%

Sickness absence after carpal tunnel release: a multicentre prospective cohort study

et al. 2021

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ObjectivesTo describe when patients return to different types of work after elective carpal tunnel release (CTR) surgery and identify the factors associated with the duration of sickness absence.DesignMulticentre prospective observational cohort study.Setting and participantsParticipants were recruited preoperatively from 16 UK centres and clinical, occupational and demographic information were collected. Participants completed a weekly diary and questionnaires at four and 12 weeks postoperatively.OutcomesThe main outcome was duration of work absence from date of surgery to date of first return to work.Results254 participants were enrolled in the study and 201 provided the follow-up data. Median duration of sickness absence was 20 days (range 1–99). Earlier return to work was associated with having surgery in primary care and a self-reported work role involving more than 4 hours of daily computer use. Being female and entitlement to more than a month of paid sick leave were both associated with longer work absences. The duration of work absence was strongly associated with the expected duration of leave, as reported by participants before surgery. Earlier return to work was not associated with poorer clinical outcomes reported 12 weeks after CTR.ConclusionsThere was wide variation in the duration of work absence after CTR across all occupational categories. A combination of occupational, demographic and clinical factors was associated with the duration of work absence, illustrating the complexity of return to work decision making. However, preoperative expectations were strongly associated with the actual duration of leave. We found no evidence that earlier return to work was harmful. Clear, consistent advice from clinicians preoperatively setting expectations of a prompt return to work could reduce unnecessary sickness absence after CTR. To enable this, clinicians need evidence-informed guidance about appropriate timescales for the safe return to different types of work.

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Section: Discussionmentioning

confidence: 77%

Sickness absence after carpal tunnel release: a multicentre prospective cohort study

et al. 2021

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“…The higher risk of scar related complications was always a non-neglectable issue for conventional open CTR procedure [5,24], and in this study 3, cases of persistent scar tenderness and pillar pain and 1 case of hypertrophic scars were encountered. Also 1 case of injury to the motor recurrent branch of median nerve was encountered, which was presumed to be associated with the variability of the recurrent branch, despite with a low incidence [25].…”

Section: Discussionmentioning

confidence: 61%

“…Conventional open carpal tunnel release (CTR) remains the gold standard for surgical treatment of CTS, due to it allowing direct vision of the ligament and surrounding vital anatomic structures. However, the complications directly related to the incision such as cosmetic concern, scar tenderness, pillar pain, and even reflex sympathetic dystrophy might compromise the surgical effectiveness [4,5]. In contrast, minimally invasive surgery via mini-or limited open incision approach has gained increasingly more popularity due to minimal soft-tissue trauma, less scar or pillar pain, better appearance, and allowing more quickly return to work and daily activities [4,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Mini-transverse incision using a novel bush-hook versus conventional open incision for treatment of carpal tunnel syndrome: a prospective study

Wang

Yong-fang

et al. 2021

J Orthop Surg Res

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Purpose This study aimed to investigate the outcomes of a mini-transverse incision with a bush-hook versus a conventional open incision for carpal tunnel release (CTR). Methods This was a prospective study. The decision to receive either technique (mini-transverse incision with a bush-hook or conventional open incision) was primarily based on patients’ choice. Patients’ symptom severity, functional status, and symptomatic pain were measured at pre-operation, 1 month, and 3 and 6 months postoperatively, and any relevant complications were recorded. Kelly’s scale was used to evaluate the overall clinical efficacy. Results Eighty-nine patients were included in the open CTR group and 85 patients in the mini-transverse incision group. The mini-transverse incision group had a significantly smaller incision (4.4±0.6 vs 44.8±3.7 mm), shorter surgical time (7.8±1.9 vs 21.2±3.4 min), and shorter hospital stay (3.7±1.6 vs 5.9±2.0 days) than did the open CTR group. Both groups showed significant improvements from baseline levels (all P<0.001). At postoperative 1 month and 3 months, the transverse incision group showed a significantly better VAS, SSS, and FSS (all P<0.05), but the difference was non-significant at 6 months except for FSS (P=0.022). Also, mini-transverse incision showed a significantly reduced time to return to work and activities, trend to a higher rate of excellence, and good and fewer complications than did the open CTR. Conclusions The mini-transverse incision exhibited better performance in surgery-related measures, symptomatic remission, functional recovery, and postoperative morbidity, thus could be considered a promising technique alternative.

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“…To achieve this, three types of procedures have been designed: open or standard, endoscopic and minimally invasive. A very high success rate has been reported with any of these mentioned procedures, with minimum complications' frequency [3] . Nevertheless, most of the reported studies only describe the benefits of the technique under study.…”

Section: Introductionmentioning

confidence: 89%

Effectiveness of mini-transverse incision versus traditional reduced technique in the treatment of carpal tunnel syndrome. A prospective cohort study

Oropeza-Duarte¹,

Ramos-Maciel²,

Naranjo-Hernández

et al. 2021

International Journal of Surgery Case Reports

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Background Carpal tunnel syndrome has attracted attention as an occupational disease due to the dramatic increase on its magnitude, and its prevalence in the general population, who's has been reported from a 0.6 to 3.4%. Currently, there are various techniques for its approach. However, there is great controversy when it comes to establishing which of the methods is the most beneficial. The objective of this study was to compare the efficacy of the mini-transverse incision against the traditional longitudinal technique in treatment of carpal tunnel syndrome. Materials and methods A series of cases is presented, prospectively included, of patients with a diagnosis of carpal tunnel syndrome, who are beneficiaries of a government hospital. We present a series of cases with a diagnosis of carpal tunnel syndrome, which were performed with two different techniques. Both techniques were evaluated by comparing the recovery and work reintegration times, as well as the decrease in pain and the absence of complications. Results A total of 8 patients operated with a minimal incision and 9 with a traditional reduced incision were studied. Significant differences were shown in the days taken to return to work, with a median of 17.5 (q25-q75 14–21) days for mini-transverse incision group and of 28 (q25-q75 21–28) days for the longitudinal traditional incision group ( p = 0.002). Likewise, differences were obtained in the visual analogue pain scale during the first week of evaluation 4 vs 7 ( p = 0.000), in contrast to complications where there were no differences at all. Conclusion The results obtained corroborate a greater efficacy of the mini-transverse incision technique, in reducing disability times. This favors the health institution to reduce the costs of rehabilitation and for the patient to have a prompt work reintegration. It is suggested to strengthen the scientific evidence that supports the use of this technique by exploring other areas such as functional status or long-term benefits.

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Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials

Cited by 81 publications

References 62 publications

Sickness absence after carpal tunnel release: a multicentre prospective cohort study

Sickness absence after carpal tunnel release: a multicentre prospective cohort study

Mini-transverse incision using a novel bush-hook versus conventional open incision for treatment of carpal tunnel syndrome: a prospective study

Effectiveness of mini-transverse incision versus traditional reduced technique in the treatment of carpal tunnel syndrome. A prospective cohort study

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