Surgical Release Procedure
Limited evidence supports that if surgery is chosen, a practitioner might consider using endoscopic carpal tunnel release based on possible short term benefits.
Rationale
Eleven high quality (Atroshi 2006, Atroshi 2009, Ejiri 2012, Kang 2013, Larsen 2013, MacDermid 2003, Malhotra 2007, Saw 2003, Sennwald 1995, Trumble 2002, and Wong 2003) and 6 moderate quality (Agee 1992, Aslani 2012, Dumontier 1995, Ferdinand 2002, Jacobsen 1996, and Tian 2007) studies evaluated whether endoscopic carpal tunnel release provided any benefit over open or “mini-open” release at early follow up (3 months to one year). Three high quality studies (Atroshi 2009, Saw 2003 and Trumble 2002) favored endoscopic release for symptom relief in the first 3-6 months after surgery and one study (Saw 2003) demonstrated an earlier return to work. One high quality (Atroshi 2009) and one moderate quality study (Tian 2007) examined long term outcomes for endoscopic release versus open release and did not find any advantage of one method over the other. Studies comparing “mini-open” to standard release were inconclusive.
- Agee,J.M.; McCarroll,H.R.,Jr.; Tortosa,R.D.; Berry,D.A.; Szabo,R.M.; Peimer,C.A. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am; 1992/11: 6
- Aslani,H.R.; Alizadeh,K.; Eajazi,A.; Karimi,A.; Karimi,M.H.; Zaferani,Z.; Hosseini Khameneh,S.M. Comparison of carpal tunnel release with three different techniques. Clin Neurol Neurosurg.; 2012/9: 7
- Atroshi,I.; Hofer,M.; Larsson,G.U.; Ornstein,E.; Johnsson,R.; Ranstam,J. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am; 2009/2: 2
- Atroshi,I.; Larsson,G.U.; 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. ; 2006/6/24: 7556
- Dumontier,C.; Sokolow,C.; Leclercq,C.; Chauvin,P. Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study. J Hand Surg Br; 1995/10: 5
- Ejiri,S.; Kikuchi,S.; Maruya,M.; Sekiguchi,Y.; Kawakami,R.; Konno,S. Short-term results of endoscopic (Okutsu method) versus palmar incision open carpal tunnel release: a prospective randomized controlled trial. Fukushima J Med Sci; 2012: 1
- Ferdinand,R.D.; MacLean,J.G. Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. J Bone Joint Surg Br; 2002/4: 3
- Jacobsen,M.B.; Rahme,H. A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release. J Hand Surg Br; 1996/4: 2
- Kang,H.J.; Koh,I.H.; Lee,T.J.; Choi,Y.R. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res.; 2013/5: 5
- Larsen,M.B.; Sorensen,A.I.; Crone,K.L.; Weis,T.; Boeckstyns,M.E. Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur.Vol.; 2013/7: 6
- MacDermid,J.C.; Richards,R.S.; Roth,J.H.; Ross,D.C.; King,G.J. Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg Am; 2003/5: 3
- Malhotra,R.; Kiran,E.K.; Dua,A.; Mallinath,S.G.; Bhan,S. Endoscopic versus open carpal tunnel release: A short-term comparative study. Indian J Orthop; 2007/1: 1
- Saw,N.L.; Jones,S.; Shepstone,L.; Meyer,M.; Chapman,P.G.; Logan,A.M. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg Br; 2003/10: 5
- Sennwald,G.R.; Benedetti,R. The value of one-portal endoscopic carpal tunnel release: a prospective randomized study. Knee Surg Sports Traumatol.Arthrosc.; 1995: 2
- Tian,Y.; Zhao,H.; Wang,T. Prospective comparison of endoscopic and open surgical methods for carpal tunnel syndrome. Chin Med Sci J; 2007/6: 2
- Trumble,T.E.; Diao,E.; Abrams,R.A.; Gilbert-Anderson,M.M. Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial. J Bone Joint Surg Am; 2002/7: 7
- Wong,K.C.; Hung,L.K.; Ho,P.C.; Wong,J.M. Carpal tunnel release. A prospective, randomised study of endoscopic versus limited-open methods. J Bone Joint Surg Br; 2003/8: 6