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Randomized Controlled Trial
. 2006 Jun 24;332(7556):1473.
doi: 10.1136/bmj.38863.632789.1F. Epub 2006 Jun 15.

Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial

Isam Atroshi  1 , Gert-Uno Larsson, Ewald Ornstein, Manfred Hofer, Ragnar Johnsson, Jonas Ranstam
Affiliations
Randomized Controlled Trial

Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial

Isam Atroshi et al. BMJ. .

Abstract

Objectives: To compare endoscopic and open carpal tunnel release surgery among employed patients with carpal tunnel syndrome.

Design and setting: Randomised controlled trial at a single orthopaedic department.

Participants: 128 employed patients aged 25-60 years with clinically diagnosed and electrophysiologically confirmed idiopathic carpal tunnel syndrome.

Main outcome measures: The primary outcome was severity of postoperative pain in the scar or proximal palm and the degree to which pain or tenderness limits activities, each rated on a 4 point scale, transformed into a combined score of 0 (none) to 100 (severe pain or tenderness causing severe activity limitation). The secondary outcomes were length of postoperative work absence, severity of symptoms of carpal tunnel syndrome and functional status scores, SF-12 quality of life score, and hand sensation and strength (blinded examiner); follow-up at three and six weeks and three and 12 months.

Results: 63 patients were allocated to endoscopic surgery and 65 patients to open surgery, with no withdrawals or dropouts. Pain in the scar or proximal palm was less prevalent or severe after endoscopic surgery than after open surgery but the differences were generally small. At three months, pain in the scar or palm was reported by 33 patients (52%) in the endoscopic group and 53 patients (82%) in the open group (number needed to treat 3.4, 95% confidence interval 2.3 to 7.7) and the mean score difference for severity of pain in scar or palm and limitation of activity was 13.3 (5.3 to 21.3). No differences between the groups were found in the other outcomes. The median length of work absence after surgery was 28 days in both groups. Quality of life measures improved substantially.

Conclusions: In carpal tunnel syndrome, endoscopic surgery was associated with less postoperative pain than open surgery, but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain.

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Figures

Fig 1
Fig 1
Flow of trial participants and the outcome measures
Fig 2
Fig 2
Proportion of patients for each self rated category of postoperative pain in the scar and proximal palm after endoscopic surgery and open surgery
Fig 3
Fig 3
Kaplan-Meier survival curve for the duration of work absence after surgery
See this image and copyright information in PMC

Comment in

References

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