Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 4, pp 585–593 | Cite as

Effectiveness and safety of endoscopic versus open carpal tunnel decompression

  • Long Chen
  • Xin Duan
  • Xiao Huang
  • Jingtong Lv
  • Kun Peng
  • Zhou XiangEmail author
Handsurgery

Abstract

Purpose

To evaluate the effectiveness and safety of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) using a meta-analysis of data from randomized controlled trials.

Materials and methods

Electronic searches of the Cochrane Register of Controlled Trials (CENTRAL, Issue 11 of 12, Nov 2012), PUBMED (1980 to Dec 2012), and EMBASE (1980 to Dec 2012) were used to identify randomized controlled trials that evaluated endoscopic vs open methods for treatment of carpal tunnel syndrome. Studies to be used were independently identified by two researchers. The methodological quality of the studies was assessed by the Cochrane Collaboration tool for assessing risk of bias.

Results

Fifteen randomized controlled trials involving 1,596 hands were included. Based on the Cochrane Collaboration tool for assessing risk of bias, four studies were rated as high quality, five studies were rated as moderate quality, and six were rated as low quality. Our meta-analysis indicated that ECTR resulted in better recovery of pinch strength, earlier time of return to work, but a higher rate of reversible nerve problems (including neurapraxia and numbness) than OCTR. ECTR also resulted in a lower rate of irreversible nerve damage (P > 0.05), wound problems (including wound infection, wound hematoma and wound dehiscence) and reflex sympathetic dystrophy (P > 0.05) compared with OCTR. Our meta-analysis revealed no obvious statistical differences in relief of symptoms (pain and paraesthesia), recovery of grip strength and reoperation rate.

Conclusion

Our meta-analysis of available randomized controlled trials demonstrated that ECTR and OCTR were similar in relief of symptoms, but ECTR resulted in better recovery of function and earlier return to work and was safer than OCTR.

Keywords

Carpal tunnel syndrome Effectiveness Endoscopic carpal tunnel release Meta-analysis Open carpal tunnel release Safety 

References

  1. 1.
    Stecco C, Aldegheri R (2008) Historical review of carpal tunnel syndrome. Chir Org Mov 92(1):7–10CrossRefGoogle Scholar
  2. 2.
    Atroshi I et al (2011) Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med 171(10):943–944PubMedCrossRefGoogle Scholar
  3. 3.
    Latinovic R, Gulliford MC, Hughes RA (2006) Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry 77(2):263–265PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Duncan KH et al (1987) Treatment of carpal tunnel syndrome by members of the American Society for surgery of the hand: results of a questionnaire. J Hand Surg Am 12(3):384–391PubMedCrossRefGoogle Scholar
  5. 5.
    Faraj AA, Ahmed MH, Saeed OA (2012) A comparative study of the surgical management of carpal tunnel syndrome by mini-transverse wrist incisions versus traditional longitudinal technique. Eur J Orthop Surg Traumatol 22(3):221–225CrossRefGoogle Scholar
  6. 6.
    Kessler FB (1986) Complications of the management of carpal tunnel syndrome. Hand Clin 2(2):401–406PubMedGoogle Scholar
  7. 7.
    Scholten RJ et al (2007) Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 17(4)Google Scholar
  8. 8.
    Agee JM et al (1992) Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am 17(6):987–995PubMedCrossRefGoogle Scholar
  9. 9.
    Chow JC (1989) Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy 5(1):19–24PubMedCrossRefGoogle Scholar
  10. 10.
    Okutsu I et al (1989) Endoscopic management of carpal tunnel syndrome. Arthroscopy 5(1):11–18PubMedCrossRefGoogle Scholar
  11. 11.
    Thoma A et al (2004) A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg 114(5):1137–1146PubMedCrossRefGoogle Scholar
  12. 12.
    Helm RH, Vaziri S (2003) Evaluation of carpal tunnel release using the Knifelight instrument. J Hand Surg Br 28(3):251–254PubMedCrossRefGoogle Scholar
  13. 13.
    Lee WP, Strickland JW (1998) Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg 101(2):418–424PubMedCrossRefGoogle Scholar
  14. 14.
    Bromley GS (1994) Minimal-incision open carpal tunnel decompression. J Hand Surg Am 19(1):119–120PubMedCrossRefGoogle Scholar
  15. 15.
    Brown RA et al (1993) Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods. J Bone Jt Surg Am 75(9):1265–1275Google Scholar
  16. 16.
    Erdmann MW (1994) Endoscopic carpal tunnel decompression. J Hand Surg Br 19(1):5–13PubMedCrossRefGoogle Scholar
  17. 17.
    Dumontier C, et al (1995) Early results of conventional versus two-portal endoscopic carpal tunnel release—a prospective study. J Hand Surg 20B(5):658–662Google Scholar
  18. 18.
    Sennwald GR, Benedetti R (1995) The value of one-portal endoscopic carpal tunnel release: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 3(2):113–116PubMedCrossRefGoogle Scholar
  19. 19.
    Benedetti VR, Sennwald G (1996) Agee endoscopic decompression of the median nerve: prospective study with comparison to open decompression. Handchir Mikrochir Plast Chir 28(3):151–155PubMedGoogle Scholar
  20. 20.
    Jacobsen MB, Rahme H (1996) A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release. J Hand Surg Br 21(2):202–204PubMedCrossRefGoogle Scholar
  21. 21.
    Stark B, Engkvist-Lofmark C (1996) Carpal tunnel syndrome. Endoscopic release or conventional surgery. Handchir Mikrochir Plast Chir 28(3):128–132PubMedGoogle Scholar
  22. 22.
    Ferdinand RD, MacLean JGB (2002) Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. J Bone Jt Surg Ser B 84(3):375–379CrossRefGoogle Scholar
  23. 23.
    Trumble TE et al (2002) Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. J Bone Jt Surg Ser A 84(7):1107–1115Google Scholar
  24. 24.
    Eichhorn J, Dieterich K (2003) Open versus endoscopic carpal tunnel release. Results of a prospective study. Chirurgische Praxis 61(2):279–283Google Scholar
  25. 25.
    MacDermid JC et al (2003) Endoscopic versus open carpal tunnel release: a randomized trial. J Hand Surg 28(3):475–480CrossRefGoogle Scholar
  26. 26.
    Saw NLB, et al (2003) Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg 28B(5):444–449Google Scholar
  27. 27.
    Malhotra R et al (2007) Endoscopic versus open carpal tunnel release: a short-term comparative study. Indian J Orthop 41(1):57–61PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Tian Y, Zhao H, Wang T (2007) Prospective comparison of endoscopic and open surgical methods for carpal tunnel syndrome. Chin Med Sci J 22(2):104–107PubMedGoogle Scholar
  29. 29.
    Atroshi I et al (2009) Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am 34(2):266–272PubMedCrossRefGoogle Scholar
  30. 30.
    Aslani HR et al (2012) Comparison of carpal tunnel release with three different techniques. Clin Neurol Neurosurg 114(7):965–968PubMedCrossRefGoogle Scholar
  31. 31.
    Atroshi I et al (2006) Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ 332(7556):1473PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration http://www.cochrane-handbook.org
  33. 33.
    Cook DJ, Sackett DL, Spitzer WO (1995) Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam consultation on meta-analysis. J Clin Epidemiol 48(1):167–171PubMedCrossRefGoogle Scholar
  34. 34.
    Boeckstyns ME, Sorensen AI (1999) Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release? An analysis of published series. J Hand Surg Br 24(1):9–15PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Long Chen
    • 1
  • Xin Duan
    • 1
  • Xiao Huang
    • 1
  • Jingtong Lv
    • 1
  • Kun Peng
    • 1
  • Zhou Xiang
    • 1
    Email author
  1. 1.Department of Orthopaedics, West China HospitalSichuan UniversityChengduChina

Personalised recommendations