Treatment of Carpal Tunnel Syndrome

Abstract

Three series of cases of Carpal Tunnel Syndrome have been studied. One series was treated a different, respected surgical team, the second series by the author by decompression alone, and the third series by additional intraneural decompression using the microscope. The authors found very little difference in the results, apart from marginally better results in the presence of thenar muscle involvement.

Outcomes of open and endoscopic carpal tunnel release: a meta-analysis

“…Variation in technique among authors is another important factor to consider. There are two basic approaches: open CTR (OCTR) versus ECTR with multiple minor variants in technique [2–5,7,9,11–19,21,22,24–27,31,34,35,40,42]. The first OCTR paper was published in 1933 by Learmonth using a long lazy-S incision to traverse the palmar wrist crease and ensure complete division of the transverse carpal ligament and the distal aspect of the deep anterior antebrachial fascia [20].…”

“…This procedure carried with it a significant morbidity attributed to the large incision. Thus, leading to the development of endoscopic methods [1,2,5,11–17,19,22,27,40,42]. Klein proposed that endoscopic release offered quicker recovery, decreased scar tenderness, and earlier return to work/daily activities.…”

“…Therefore one can define experience with ECTR as having performed greater than 100 releases. However, the open methods require less skill in the use of tools and techniques, therefore, less dependent on experience to minimize complications [2–5,7,9,11–13,16,17,21,22,24–26,31,34,40,42]. The endoscopic approach, regardless of technique, has been associated with a steeper learning curve, higher complication rate, and higher rate of incomplete release when compared to the standard open carpal tunnel approach [3,5,7,9,11,13].…”

“…Twenty-two studies [2–5,7,9,11,13–19,21,24–26,31,34,35,40,42] published in peer reviewed journals from 1966 to 2003 were identified with “Medline” which met criteria of high relevance and quality [42]. Prospective randomized controlled and retrospective studies were selected if they included at least 20 patients, where the principal intervention involved surgery, and with a follow-up of at least three (average of six) of the selected nine CTR outcome parameters: (1) paresthesia relief, (2) scar tenderness, (3) two-point discrimination, (4) thenar weakness, (5) SW monofilament testing, (6) return to work time, (7) grip strength, (8) pinch strength, and (9) complications (Table 1) for at least 6 months.…”

Importance of Recognizing Carpal Tunnel Syndrome for Neurosurgeons: A Review

“…In such cases, longitudinal epineurotomy of the nerve has been suggested as an option that could convey greater pressure release, more prominent nerve volume recovery, and better outcomes. 64,65) Consequently, this method has been widely used, although a recent randomized controlled trial failed to demonstrate additional benefits of epineurotomy on the electrophysiological and clinical outcomes. 66) …”