A Randomized Comparison of Double Small, Standard, and Endoscopic Approaches for Carpal Tunnel Release

A Modified Endoscopic Carpal Tunnel Release Surgery

In this study, a modified version of the endoscopic carpal tunnel release surgery was introduced, which is safe and easy to handle. Moreover, the requirement for surgical instruments is low. Six patients with carpal tunnel syndrome underwent the modified procedure. No neurovascular injuries occurred in these patients. According to the one-year follow-up data, all the patients were satisfied with the outcomes. The modified endoscopic carpal tunnel release technique has been proven to be safe with satisfactory outcomes in six patients in this study.

Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance in Over 100 Patients at Two to Six Years

Purpose

The purpose of this study was to determine the clinical results of carpal tunnel release using ultrasound guidance (CTR-US) at a minimum of 2 years postprocedure.

Methods

The study consisted of 102 patients (162 hands) treated with CTR-US by the same physician between June 2017 and October 2020 for whom minimum 2-year follow-up data were available. Questionnaires were sent to gather long-term information, with additional phone calls for clarification if needed. Outcomes included Boston Carpal Tunnel Questionnaire symptom severity (BCTQ-SSS) and functional status (BCTQ-FSS) scores; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores; global satisfaction scores; and subsequent surgeries.

Results

The 102 patients included 68 females and 34 males with a mean age of 56.9 years at the time of surgery. Fifty-five (53.9%) patients had simultaneous bilateral procedures, 42 (41.2%) had unilateral procedures, and 5 (4.9%) had staged bilateral procedures. Significant improvements in BCTQ-SSS, BCTQ-FSS, and QuickDASH scores persisted at a mean final follow-up of 46 months (range 2-6 years). At final follow-up, 91.2% of patients reported satisfaction with the procedure. No outcomes were significantly different between those treated with simultaneous bilateral versus unilateral procedures. No revision surgeries were reported.

Conclusions

CTR-US is a safe and effective procedure that results in significant improvements that persist up to 6 years postprocedure. Long-term results of simultaneous bilateral and unilateral procedures are similar.

Type of study/level of evidence

Therapeutic IV.

State of the art review. Complications after carpal tunnel release

Carpal tunnel release (CTR) is the most performed surgery of the upper extremity. It is effective but not without complications. This state-of-the-art review covers most common intra- and postoperative complications after CTR. As endoscopic carpal tunnel release (ECTR) has developed over time, severe complications, such as nerve lesions, have diminished. ECTR still has a higher risk on transient nerve lesions. Open CTR on the other hand has a higher incidence of wound-related problems, including scar tenderness, irrespective of incision used. Most complications, such as pillar pain and infection, are ill-defined in the literature, leaving the exact incidence unknown and proposing challenges in treatment. The same is true for failure of treatment. Optimizing the length and location of incisions has played a vital role in reducing intra- and postoperative complications in CTR. It is expected that technical advances, such as ultrasound-guided percutaneous carpal tunnel release, will continue to play a role in the future.Level of evidence: V.

Best-Evidence Systematic Review and Meta-Analysis of Mini-Open Carpal Tunnel Release

Purpose

This study aimed to evaluate the safety and effectiveness of mini-open carpal tunnel release (mOCTR) using best-evidence synthesis methods.

Methods

We systematically searched for prospective studies published from January 2013 to July 2023 that reported outcomes from a minimum of 50 mOCTR cases. The outcomes included Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), pain visual analog scale (VAS), complication rate, and reoperation rate. Data analysis was performed using a random-effects meta-analysis, with metaregression to identify the associations between patient- and study-level factors with surgical outcomes.

Results

The meta-analysis included 23 studies with 2,303 patients followed for median durations ranging from 6 to 12 months depending on the outcome. Mini-open carpal tunnel release resulted in statistically significant and clinically important improvements in Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (mean difference = -25.5; 95% confidence interval [CI]: -36.4 to -14.5; P < .001), BCTQ-SSS (mean difference = -2.2; 95% CI: -2.5 to -1.9; P < .001), BCTQ-FSS (mean difference = -2.1; 95% CI: -2.4 to -1.7; P < .001), and pain VAS (mean difference = -5.1; 95% CI: -6.2 to -4.1; P < .001). The sole predictor of improvement in BCTQ-SSS, BCTQ-FSS, and pain VAS was a higher preoperative score for the respective variable (all P < .001). The risk of complications (mainly short-term pillar pain or scar complications) was 8.9% (95% CI: 4.0%-13.8%) and increased with longer incision lengths (P = .008). Revision carpal tunnel release was performed in 0.6% (95% CI: 0.1%-1.0%) of the cases during follow-up. No cases of median nerve transection were reported.

Conclusions

Based on a best-evidence meta-analysis of contemporary studies, mOCTR significantly improved function and pain, with a relatively low risk of mainly temporary complications. Patient outcomes after mOCTR were influenced by patient symptomatology and surgical incision length.

Clinical relevance

Mini-open carpal tunnel release is an effective surgical option that significantly improves symptoms and function, especially for patients with more severe baseline dysfunction. Surgeons should use the shortest incision that allows adequate visualization to safely divide the transverse carpal ligament.

Best-Evidence Systematic Review and Meta-Analysis of Endoscopic Carpal Tunnel Release Outcomes

Purpose

The aim of this systematic review and meta-analysis was to evaluate the safety and effectiveness of endoscopic carpal tunnel release (ECTR) using best-evidence synthesis methods.

Methods

A systematic search of multiple databases was conducted for prospective contemporary studies published between January 2013 and January 2023 with at least 50 ECTR cases. Outcomes included the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH) measured on a 0-100 scale, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS) on a 1-5 scale, pain visual analog scale on a 0-10 scale, conversion to open carpal tunnel release (CTR), complications, and reoperations. Outcomes were analyzed using a random-effects meta-analysis model. Metaregression was used to determine the association of patient- and study-level factors with ECTR outcomes.

Results

A total of 17 studies with 1,632 patients treated with ECTR were included. Median follow-up durations ranged from 4 to 7 months depending on the outcome. Statistically significant and clinically important improvements were noted after ECTR for Q-DASH, BCTQ-SSS, BCTQ-FSS, and pain visual analog scale scores, with mean differences from baseline of -28.8, -1.8, -1.5, and -5.1, respectively (P < .001 for all). In metaregression, the strongest predictor of improvement in Q-DASH, BCTQ-SSS, and BCTQ-FSS was a greater preoperative score for that variable (all P ≤ .005), indicating that patients with worse symptoms improved the most. The risks of conversion to open CTR, complications, and revision CTR were 0.7%, 0.7%, and 0.5%, respectively.

Conclusions

In a best-evidence synthesis of contemporary studies, ECTR resulted in significant improvements in function and pain, with a low risk of conversion to open surgery, complications, and reoperations over short-term follow-up.

Clinical relevance

Patients treated with ECTR can expect generally favorable clinical outcomes over the short term. However, long-term outcomes after ECTR are not well characterized.

Factors Associated with the Return to Work after Carpal Tunnel Release Surgery: A Cross-Sectional Study of the Worker Population

Background: There is controversy regarding the factors influencing the duration of sickness absence and return to work (RTW) after surgical treatment of carpal tunnel syndrome (CTS). This study aimed to determine factors related to RTW in these patients. Methods: This descriptive-analytical study was performed on all patients with CTS who underwent surgery in a main orthopaedic centre from December 2020 to April 2021. Patients were followed for 90 days after surgery for the RTW. The patients were classified into two groups based on the time of RTW, early (<21 days) and late (>21 days). These two groups were compared in terms of occupational, individual and disease-related factors and the type of surgery. Results: The mean time to RTW in patients was 23.2 ± 7.1 days, with a range of 7-60 days. There was a statistically significant relationship between early RTW and gender (female) (p = 0.005 OR = 6.5), non-manual work (p = 0.002 OR = 1.2), the total score of the Boston carpal tunnel questionnaire before surgery and job satisfaction (p = 0.04). The mean time to RTW in patients who underwent open surgery was less than in endoscopic surgery (22.89 ± 6.29 vs. 24.58 ± 4.7), but this difference was not statistically significant (p > 0.05). Conclusions: Based on the findings of our study, the type of surgery does not affect the RTW of patients with CTS. Considering the effect of job type and job satisfaction on RTW, it is recommended to pay attention to the type of occupation in addition to the type of surgery so that this workforce can RTW with good performance. Level of Evidence: Level IV (Therapeutic).

Endoscopic Release Superficial Rather Than Deep to the Transverse Carpal Ligament for Carpal Tunnel Syndrome Improves Immediate Postoperative Transient Symptomatic Exacerbation With Fewer Absences From Work

PURPOSE

To determine the endoscopic release superficially rather than deep to the transverse carpal ligament to reduce the incidence of transient symptomatic exacerbation and postoperative absence from work in patients with carpal tunnel syndrome.

METHODS

From January 2012 to January 2018, patients with idiopathic carpal tunnel syndrome who underwent one-portal endoscopic release superficial to the transverse carpal ligament (ERSTCL) were analyzed. For comparison, a cohort treated with the conventional Chow endoscopic release between February 2008 and October 2013 were included. Transient worsening of symptoms, discrimination sensation, and days off work were assessed. The minimal clinically important difference was calculated for discrimination sensation. Severity of symptom and functional status also were assessed using the Levine-Katz Questionnaire. Significance was set at P < .05.

RESULTS

There was a significant difference between the ERSTCL group and the control group regarding the incidence of symptomatic exacerbation 1 week after surgery (2% vs 9%; P = .003) but no difference in other time intervals within the initial 3 months. There was a significant difference in 2-point discrimination 1 week (mean change = -0.13, 95% confidence interval [CI] -0.30 to 0.04, P = .01) and 2 weeks after surgery (mean change = -0.18, 95% CI -0.36 to -0.01, P = .033). Postoperative 1 and 2 weeks, 28% and 35% patients in ERSTCL group achieved a minimal clinically important difference, respectively. Compared with control group, the difference in frequencies was statistically significant (28% vs 45%; P = .027; 35% vs 57%; P = .015). The difference between the 2 groups in postoperative absence from work was statistically significant (95% CI 1.083-4.724; P = .002), with an average reduction in sick leave of 3 days in ERSTCL group. At a mean follow-up of 3 years, no significant difference was found between the groups regarding symptom and function statuses.

CONCLUSIONS

Endoscopic release superficial rather than deep to transverse carpal ligament for carpal tunnel syndrome improves immediate postoperative transient symptomatic exacerbation, which allows the patients to return to work earlier.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Carpal tunnel syndrome: updated evidence and new questions

Carpal tunnel syndrome is the most common entrapment neuropathy, affecting quality of life for many people. Although it is a well recognised condition, new insights into epidemiology, diagnosis, and treatment have emerged in the past 6 years. The availability of disease-modifying treatments for rare systemic disorders associated with carpal tunnel syndrome (eg, amyloidosis) should alert clinicians to these diagnostic possibilities. Besides clinical evaluation and electrophysiology, the role of ultrasonography as a diagnostic tool has been confirmed and new ultrasound techniques have been applied, the clinical use and feasibility of which require further investigation. Surgical and non-surgical interventions are beneficial for the treatment of carpal tunnel syndrome and several treatment options are now available, giving clinicians the possibility to choose the best approach for every patient. New diagnostic and therapeutic techniques require further validation.

A Retrospective Clinical Study of Endoscopic Treatment of Carpal Tunnel Syndrome using the Modified Soft Tissue Release kit

OBJECTIVE

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, and endoscopic carpal tunnel release (ECTR) is one of the minimally invasive procedures for the treatment of CTS. Based on the shortcomings of ECTR, we designed the "Modified Soft Tissue Release Kit" to assist the endoscopic operation. This study aimed to evaluate the effectiveness and safety of endoscopic treatment of CTS using this kit.

METHODS

This retrospective review included 57 patients (86 wrists) who underwent ECTR using the "Modified Soft Tissue Release Kit" at our department between January 2017 and August 2019. Three scale scores (i.e., Quick-Disabilities of the Arm, Shoulder, and Hand [QDASH]; Boston Carpal Tunnel Syndrome Questionnaire [BCTSQ]: symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS]) were recorded to assess hand function and symptoms preoperatively, 1 month postoperatively, 3 months postoperatively, and at the last follow-up. We also asked patients to answer a satisfaction question during follow-up. Pre- and post-operation scores were compared using paired Wilcoxon signed-rank test. Spearman's rank-order correlation was used to evaluate the relationship between scale scores and patient satisfaction.

RESULTS

A total of 55 patients (83 wrists) were followed up, with an average follow-up of 27.2 ± 9.3 months. The median preoperative QDASH score was 45.5; the scores at 1 month postoperatively, 3 months postoperatively, and the last follow-up were 4.5, 0, and 0, respectively, with a significant decrease noted compared with the preoperative scores (P < 0.001). The median preoperative BCTSQ-SS and BCTSQ-FS scores were 3.3 and 2.8, respectively; the scores at 1 month postoperatively, 3 months postoperatively, and the last follow-up were 1.2, 1.0, and 1.0, and 1.1, 1.0, and 1.0, respectively, all of which decreased significantly compared with the preoperative scores (P < 0.001). The incidence of nerve injury was 0. The incidence of pillar pain was 0 at the last follow-up. One patient showed no improvement in hand symptoms and function postoperatively, and two patients showed long-term recurrence despite postoperative symptom remission. Approximately 94.5% (52/55) of the patients were satisfied or very satisfied with the outcome.

CONCLUSIONS

ECTR with the "Modified Soft Tissue Release Kit" can significantly relieve symptoms and improve function in patients with CTS, with significant short- and mid-term efficacy and high safety.

Short incision versus minimally invasive surgery with tool-kit for carpal tunnel syndrome release: a prospective randomized control trial to evaluate the anterior wrist pain and time to return to work or activities

Trial design

The prospective randomized controlled trial.

Background

This study compares outcomes in terms of early postoperative anterior wrist pain and time to return to work or activities of daily living of patients who underwent carpal tunnel syndrome (CTS) release with short incision and those who had minimally invasive surgery (MIS) with CTS kits.

Methods

A total of 24 patients diagnosed with primary CTS confirmed with electrodiagnosis at an academic university hospital were randomly assigned into one of two groups of 12 patients each: a short incision group and an MIS with tool-kit group using computer-generated block randomization (block of four). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. In the short incision group, skin was incised longitudinally from Kaplan’s line to the area distal to transverse wrist crease (2.5–4.0 cm) while in the tool-kit group, an incision of less than 2.5 cm. was made using special MIS-CTS kits. Primary outcomes evaluated include visual analogue scale (VAS) measurement of pain intensity in the anterior carpal area both while at rest and while conducting daily activities at the 2nd week postoperatively as well as the time to return to activities of daily living and work. Improvement in the Michigan hand questionnaire (MHQ) score, a secondary outcome, was also measured at the 2nd week postoperatively. Patients, allocator and outcome assessor were blinded.

Results

Demographic data, including preoperative electrodiagnostic severity and occupation, were similar in the two groups. There were no significant differences in terms of VAS of the early postoperative anterior carpal area at rest (p > 0.99), while conducting daily activities (p = 0.89) and time to return to activities of daily living (p = 0.46) and work (p = 0.24). The MHQ score improvement at the 2nd week postoperatively showed no significant difference between the groups (p = 0.95). The MIS wound length in the tool-kit group was significantly shorter than in the short incision group (1.95 vs 2.92 cm, p < 0.01).

Conclusions

There is no difference in early postoperative anterior wrist pain, time to return to work or to activities of daily living between the surgical techniques. Short incision is recommended for benefit in term of cost-effectiveness, while MIS with tool-kit could be preferred in patients who concerned in cosmetic appearance between the surgical techniques.

Trial registration

www.clinicaltrials.in.th (TCTR20200530003). Registered 30 May 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05663-5.

Mini-open carpal tunnel release: technique, feasibility and clinical outcome compared to the conventional procedure in a long-term follow-up

We sought to evaluate the findings of our anatomically landmarks based mini-open procedure (MCTR) through a palmar approach and to compare its outcome and practicability to the conventional method (OCTR). The study consisted of 100 matched patients (n = 50 MCTR, n = 50 OCTR) with a minimum follow-up of three years. The outcome was characterized via the Disabilities of Arm, Shoulder and Hand Score (DASH), Symptom Severity Scale (SSS), Functional Status Scale (FSC), and Visual Analogue Scale (VAS). All adverse events were observed. An alpha of 0.05 and a confidence level of 95% were set for statistical analyses. Both techniques showed comparable functional results in a long-term period (mean follow-up MCTR: 60 months and OCTR: 54 months). MCTR versus OCTR at mean: DASH: 4.6/8.3 (p = 0.398), SSS: 1.3/1.2 (p = 0.534), FSC: 1.3/1.2 (p = 0.617), VAS: 0.4/0.7 (p = 0.246). The MCTR convinced through a lower rate of scar sensibility (MCTR: 0% vs. OCTR: 12%, 0/50 vs. 6/50; p = 0.007) and pillar pain, as well as a shortened recovery period and surgical time relative to the OCTR. Low complication rates were observed in both groups, no recurrences had to be documented. The MCTR procedure revealed a similar good clinical outcome as the conventional technique. MCTR is a minimally-invasive, reliable, fast and simple procedure with an obvious benefit regarding scar sensibility.

Carpal Tunnel Release Surgery- A Systematic Review of Open and Endoscopic Approaches

CONTEXT

Carpal tunnel syndrome (CTS) is the most frequent peripheral compression-induced neuropathy observed in patients worldwide. Surgery is necessary when conservative treatments fail and severe symptoms persist. Traditional Open carpal tunnel release (OCTR) with visualization of carpal tunnel is considered the gold standard for decompression. However, Endoscopic carpal tunnel release (ECTR), a less invasive technique than OCTR is emerging as a standard of care in recent years.

EVIDENCE ACQUISITION

Criteria for this systematic review were derived from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two review authors searched PubMed, MEDLINE, and the Cochrane Database in May 2018 using the following MeSH terms from 1993-2016: 'carpal tunnel syndrome,' 'median nerve neuropathy,' 'endoscopic carpal tunnel release,' 'endoscopic surgery,' 'open carpal tunnel release,' 'open surgery,' and 'carpal tunnel surgery.' Additional sources, including Google Scholar, were added. Also, based on bibliographies and consultation with experts, appropriate publications were identified. The primary outcome measure was pain relief.

RESULTS

For this analysis, 27 studies met inclusion criteria. Results indicate that ECTR produced superior post-operative pain outcomes during short-term follow-up. Of the studies meeting inclusion criteria for this analysis, 17 studies evaluated pain as a primary or secondary outcome, and 15 studies evaluated pain, pillar tenderness, or incision tenderness at short-term follow-up. Most studies employed a VAS for assessment, and the majority reported superior short-term pain outcomes following ECTR at intervals ranging from one hour up to 12 weeks. Several additional studies reported equivalent pain outcomes at short-term follow-up as early as one week. No study reported inferior short-term pain outcomes following ECTR.

CONCLUSIONS

ECTR and OCTR produce satisfactory results in pain relief, symptom resolution, patient satisfaction, time to return to work, and adverse events. There is a growing body of evidence favoring the endoscopic technique for pain relief, functional outcomes, and satisfaction, at least in the early post-operative period, even if this difference disappears over time. Several studies have demonstrated a quicker return to work and activities of daily living with the endoscopic technique.

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

BACKGROUND

Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial.

METHODS

We comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR.

RESULTS

Our meta-analysis contained twenty-eight studies. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, - 7.25 days; 95% CI, - 14.31 to - 0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). The permanent nerve injury showed no significant differences between the two methods (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28).

CONCLUSIONS

Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions compared to OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.

The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome: A meta-analysis of randomized controlled trials

BACKGROUND

Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments.

METHODS

The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared.

RESULTS

Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86-7.65]; P = .01) and pinch strength (MD, 1.37 [0.24-2.51]; P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,-8.80 [-9.21 to -8.39]; P < .01) and reduced operative time (standardized mean difference [SMD], -1.68 [-3.24 to-0.12]; P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38-0.96, P = .03).

CONCLUSIONS

Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.

Quality of Randomized Controlled Trials for Surgical Treatment of Carpal Tunnel Syndrome: A Systematic Review

BACKGROUND

Randomized controlled trials are considered the gold standard in evidence-based medicine. The authors conducted a systematic review to evaluate the quantity, quality, and trends of randomized controlled trials that assess surgical treatment of carpal tunnel syndrome.

METHODS

The authors identified randomized controlled trials comparing two or more surgical interventions for carpal tunnel syndrome in PubMed, Cochrane, Scopus, Google Scholar, and Clinicaltrials.gov. Two independent reviewers evaluated articles for inclusion, extracted data, and assessed randomized controlled trial quality using the Jadad score.

RESULTS

Of 2253 identified studies, 58 met full inclusion criteria. They were published between 1985 and 2015, with a significant increase over time (p = 0.003). They were most frequently published in Journal of Hand Surgery (European Volume) [n = 15 (25.9 percent)]. Most randomized controlled trials were single-center studies [n = 54 (93.1 percent)] conducted in the United Kingdom [n = 13 (22.4 percent)] or the United States [n = 10 (17.2 percent)], with a mean study size of 80.1 ± 55.5 patients. Funding source was unknown in 62.1 percent (n = 36). Three-quarters [n = 44 (75.9 percent)] of randomized controlled trials did not define the primary outcome measure(s). Less than 30 percent (n = 17) of randomized controlled trials conducted a power analysis. Only four studies with patients reported lost to follow-up provided an explanation for each patient. Six randomized controlled trials (10.3 percent) conducted intention-to-treat analysis. The mean Jadad score was 2.14 ± 1.26, with no significant improvement over time (p = 0.245).

CONCLUSIONS

Despite the significant increase in the number of randomized controlled trials published studying surgical treatment of carpal tunnel syndrome over time, a mean Jadad score of 2.14 with no change over time indicates a need for improvement in quality. Proper study design is key to avoiding introduction of bias and ensuring the validity of conclusions drawn.

Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study

PURPOSE

We have make use of a new method to perform carpal tunnel release (CTR) through a 1.5-2.0 cm long incision The aim of this study is to introduce this method and to compare the effectiveness and safety of this approach to the conventional one.

METHODS

We included consecutive patients diagnosed with primary carpal tunnel syndrome (CTS) who had CTR from January 2015 to September 2016. A total of 85 patients were included in our study. Among them, 42 patients with mini-incision approach were enrolled in group A, and the other 43 patients with conventional approach were enrolled in group B. Objective tests and subjective evaluations were performed to compare the outcomes of mini-incision approach with the conventional approach. Postoperative complications after the two approaches were also compared.

RESULTS

At the 12-months follow-up, all patients in both groups got recovery. We found no significant differences between the two groups in postoperative pinch strength, grip strength, 2-point discrimination (2-PD), visual analogue scale (VAS) score, Levine score and the Disabilities of the Arm, Shoulder and Hand (DASH) score (P > 0.05). However, at the one-month follow-up, the percentage of patients with wound pain in group A was significantly lower than that in group B (0.05% vs. 0.23%, P = 0.03). At the 12 months follow-up, the number of patients with persistent wound pain and pillar pain in group B were 2 (4.7%) and 3 (7.0%) respectively, while no patients showed wound pain and pillar pain in group A.

CONCLUSION

Patients with mini-incision approach have satisfactory surgical outcomes, low postoperative complications, and good appearance.