Prospective randomized comparison of single-incision and two-incision carpal tunnel release outcomes
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This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release (CTR).
From 2008 to 2009, patients with isolated carpal tunnel syndrome were randomized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center. Pre-operatively, participants completed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ), as well as grip and pinch strength and Semmes–Weinstein monofilament sensation testing. At 2 weeks, 6 weeks and at least 6 months post-operatively, these measurements were repeated along with assessment of scar tenderness and pillar pain. Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson's correlations. Significance was set at p = 0.05.
There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores, BWCTQ scores, grip strength, pinch strength, scar tenderness, or pillar pain. The only statistically significant difference was improved sensation by Semmes–Weinstein in the single-incision group in the second finger at 6 weeks post-operatively and in the third finger at 6 months post-operatively.
The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period. However, there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6+ months post-operatively.
KeywordsCarpal tunnel syndrome Carpal tunnel release DASH Questionnaire Brigham and Women's Carpal Tunnel Questionnaire Two-incision carpal tunnel release Minimally-invasive carpal tunnel release
We thank the Stanford School of Medicine Medical Scholars Research Fellowship Program and the Department of Orthopaedic Surgery for their financial support of this project. We would also like to acknowledge David Zelouf, MD for the early development of the two-incision CTR technique utilized in this study.
Compliance with ethics requirements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.
Conflicts of Interest
Tiffany N. Castillo, MD declares that she has no conflict of interest.
Jeffrey Yao, MD declares that he has no conflict of interest in relation to this study; however, he has been a paid consultant for Arthrex, Trimed, Smith and Nephew Endoscopy, and Axogen. He has a grant from the American Foundation for Surgery of the Hand and has had honoraria and paid travel for educational speaking engagements for Arthrex and Trimed, and has patents and royalties from work with Arthrex as disclosed on his COI form.
There is no identifying patient information contained in this manuscript and all patients provided informed consent prior to participation in the study.