American Society for Peripheral Nerve

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A Prospective, Randomized Evaluation of Endoscopic versus Open Carpal Tunnel Release in Bilateral Carpal Tunnel Syndrome
Brett Michelotti, MD; Diane Romanowsky, PA-C; Randy Hauck, MD
Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA

Background: Studies have shown similar results in terms of symptom relief and incidence of complications when release of the transverse carpal ligament is performed with an open or endoscopic approach. However, there are data to suggest less post-operative pain and earlier return to work with the endoscopic technique. The goal of this study was to prospectively examine post-operative functional outcomes, patient satisfaction and complications following both endoscopic and open carpal tunnel release in the opposite hands of the same patient, serving as their own control.

Methods: This was a prospective, randomized study in which patients underwent surgery for bilateral carpal tunnel syndrome, confirmed by electrodiagnostic studies, who had failed non-surgical management. The first carpal tunnel release was performed on the most symptomatic hand – as determined by the patient. Operative approach was randomly assigned and one month later the alternative technique was performed on the contralateral side. Demographic data, duration of symptoms, previous treatment, and workman’s compensation claim status was obtained. Functional outcomes, recorded pre- and post-operatively, included EMG data, pain score, two-point discrimination, Semmes Weinstein monofilament testing, thenar strength, and overall grip strength. The CTS-FSS (carpal tunnel syndrome functional status score) and CTS-SSS (carpal tunnel syndrome symptom severity score) were recorded before surgery and at 2, 4, 8, 12 and 24 weeks post-operatively. Overall satisfaction with each technique was recorded at the conclusion of the study.

Results: Currently, we have enrolled 21 patients. When comparing pain score, two-point discrimination, Semmes Weinstein monofilament testing, thenar strength, and overall grip strength we found no differences between groups at any of the post-operative time points. Symptom severity score (CTS – SSS) and functional status score (CTS – FSS) were not significantly different between groups. Overall satisfaction, where patients recorded a number from 0 to 100, was significantly greater in the endoscopic carpal tunnel decompression group (96.0 v. 90.5, p = 0.03), though the objective data we compared do not explain this difference. There were no complications with either technique.

Discussion: This study, utilizing the same patient as an internal control, suggests that both open and endoscopic carpal tunnel release are well tolerated with no differences in functional outcomes, symptom severity and functional status questionnaires or complications. Although there were no differences between groups using our study metrics, patients still preferred the endoscopic carpal tunnel release, demonstrated by significantly higher overall satisfaction scores at the conclusion of the study.

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