A Comparison of Open versus Endoscopic Carpal Tunnel Release Within the Same Patient
Kavita T. Vakharia, MD, Brett F. Michelotti, MD, Diane Romanowsky, PA-C, Randy M. Hauck, MD.
Penn State Hershey Medical Center/College of Medicine, Hershey, PA, USA.
PURPOSE: Several studies have shown less postoperative pain and faster improvement in grip and pinch strength with the endoscopic technique. The goal of this study was to prospectively examine subjective and functional outcomes, satisfaction, and complications after both ECTR and OCTR in the opposite hands of the same patient.METHODS: This was a prospective, randomized study in which patients with bilateral carpal tunnel syndrome underwent surgical release with both endoscopic and open techniques. The initial operative approach utilized was randomly assigned to the more symptomatic hand. Demographic data and functional outcomes were recorded pre- and post-operatively, including pain, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength testing, grip strength, the carpal tunnel syndrome functional status and symptom severity scores, and overall satisfaction.RESULTS: In the 30 patients that completed the study, there were no significant differences in any measure at any of the postoperative time points. Symptom severity and functional status scores were not significantly different between groups. Subjectively, 24/30 patients did state they preferred the ECTR, mostly citing less pain as their primary reason, although pain scores were not objectively different. Differences in overall satisfaction also lost significance at the study conclusion. There were no complications with either technique.CONCLUSION: Both techniques are well tolerated with no differences in outcomes. The added cost and equipment without added benefit makes ECTR usefulness questionable. The ability to perform OCTR wide-awake and outside of the operating room has lead the senior author to go back to OCTR in the majority of patients.
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