Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases

Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 97)

Summary

Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. Follow-up was performed at 1, 3 and 6 months and overall results were backed up by telephone questionnaire (Health Outcomes Carpal Tunnel Questionnaire, Health Outcomes, Bloomington, MN, USA). Results were favourable in 98% and 2% unfavorable for persistent pain. Rate of satisfaction of the patients was 90%. Average time of patient’s return to work was 20 days. Eleven procedures (2.8%) were converted to open release. There was one case (0.2%) of incompleted section of the perineurium due to failure of endoscopic visualization of the ligament. In this case the procedure was converted to open and was completed with perineurium sutura. In six cases (1.5%) there were injury to superficial palmar arch. During the follow-up period there were no recurrences and no re-exploration. The mean preoperatively obtainable distal motor latency (DML) and sensory conduction velocity (SCV) values were 6.7 m/s and 29.2 m/s, respectively. The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.

Keywords

Carpal tunnel syndrome endoscopic release electromyographic evaluation 

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References

  1. 1.
    Abdullah AF, Wolber PH, Ditto EW III (1995) Sequelae of carpal tunnel surgery: Rationale for the design of a surgical approach. Neurosurgery 37: 931–936PubMedGoogle Scholar
  2. 2.
    Agee JM, McCaroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA (1992) Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg 17A: 987–995Google Scholar
  3. 3.
    Andrew Lee WP, Strickland JW (1998) Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg 101: 418–424PubMedGoogle Scholar
  4. 4.
    Atroshi I, Johnson R, Ornstein E (1998) Patient satisfaction and return to work after endoscopic carpal tunnel surgery. J Hand Surg 23: 58–65Google Scholar
  5. 5.
    Baldasseroni A, Tartaglia R, Carnevale F (1995) The risk of the carpal tunnel syndrome in some work activities. Med Lav 86: 341–351 (abstr)PubMedGoogle Scholar
  6. 6.
    Brief R, Brief LP (2000) Endoscopic carpal tunnel release: report of 146 cases. Mount Sinai J Med 67: 274–277Google Scholar
  7. 7.
    Bromely GS (1994) Minimal-incision open carpal tunnel decompression. J Hand Surg 19A: 119–120Google Scholar
  8. 8.
    Brown RA, Gelberman RH, Seiler JG III, Abrahamsson S-O, Weiland AJ, Urbaniak JR, Schoenfeld DA (1993) Carpal tunnel release: a prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg 75A: 1265–1275Google Scholar
  9. 9.
    Brown MG, Rothenberg ES, Reyser B, Woloszyn TT, Wolford A (1993) Results of l,236 endoscopic carpal tunnel release procedures using the Brown technique. Ctemp Orthop 27: 251–262Google Scholar
  10. 10.
    Chang MH (2002) Usefulness of sensory and motor conduction testing in carpal tunnel syndrome. Neurology 58: 1597–1607 (abstr)Google Scholar
  11. 11.
    Chen HT, Chen HC, Wei FC (1999) Endoscopic carpal tunnel release. Changgeng Yi Xue Za Zhi 22: 386–391 (abstr)PubMedGoogle Scholar
  12. 12.
    Chow JC (1989) Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy 5: 19–24PubMedGoogle Scholar
  13. 13.
    Chow JC (1999) Endoscopic release of the carpal ligament for carpal tunnel syndrome: long-term results using the Chow technique. Arthroscopy 15: 417–421PubMedGoogle Scholar
  14. 14.
    Menon J (1994) Endoscopic carpal tunnel release: preliminary report. Arthroscopy 10: 31–38PubMedGoogle Scholar
  15. 15.
    Davies BW, Pennington GA, Fritz AM (1998) Two-portal endoscopic carpal tunnel release: an outcome analysis of 333 hands. Ann Plast Surg 40: 542–548 (abstr)PubMedGoogle Scholar
  16. 16.
    Ghaly RF, Saban KL, Haley DA, Ross RE (2000) Endoscopic carpal tunnel release surgery: report of patient satisfaction. Neurol Res 22: 551–555PubMedGoogle Scholar
  17. 17.
    Jablecki CK (2002) Electrodiagnosic testing for diagnosing carpal tunnel syndrome. Neurology 58: 1583–1584 (abstr)PubMedGoogle Scholar
  18. 18.
    Jimenez DF, Gibbs SR, Clapper AT (1998) Endoscopic treatment of carpal tunnel syndrome: a critical review. J Neurosurg 88: 817–826PubMedGoogle Scholar
  19. 19.
    Kerr CD, Gittens ME, Sybert DR (1994) Endoscopic versus open carpal tunnel release: clinical results. Arthroscopy 10: 266–269PubMedGoogle Scholar
  20. 20.
    Nordstrom DL, De Stefano F, Vierkant RA, Layde PM (1998) Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 9: 342–345PubMedGoogle Scholar
  21. 21.
    Okutsu I, Ninomiya S, Natsuyama M et al (1987) Subcutaneous operation and examination under universal endoscope. J Jpn Orthop Assoc 61: 491–498Google Scholar
  22. 22.
    Okutsu I, Ninorniya S, Takatori Y, Ugawa Y (1989) Endoscopic management of carpal tunnel syndrome. Arthroscopy 5: 11–18PubMedGoogle Scholar
  23. 23.
    Papageorgiou CD, Georgoulis AD, Mekris CA, Moebius UG, Varitimidis SE, Soucacos PN (1998) Difficulties and early results of the endoscopic carpal tunnel release using the modified Chow technique. Knee Surg Sports Traumatol Arthrosc 6: 189–193 (abstr)PubMedGoogle Scholar
  24. 24.
    Senda M, Hashizume H, Terai Y, Inoue H, Nagashima H (1999) Electromyographic evaluation after endoscopic carpal tunnel release in idiopathic carpal tunnel syndrome. J Orthop Sci 4: 187–190PubMedGoogle Scholar
  25. 25.
    Shapiro S (1995) Microsurgical carpal tunnel release. Neurosurgery 37: 66–70PubMedGoogle Scholar
  26. 26.
    Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V (1994) The US prevalence of self-reported carpal tunnel syndrome: 1998 National Health Interview Survey data. Am J Public Health 84: 1846–1848 (abstr)PubMedGoogle Scholar
  27. 27.
    Thurston A, Lam N (1997) Results of open carpal tunnel release: A comprehensive, retrospective study of 188 hands. Aust NZ J Surg 67: 282–288Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Neurosurgical Unit General Hospital of CosenzaCosenzaItaly

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