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Meta-Analysis
. 2014 Jan 31;2014(1):CD008265.
doi: 10.1002/14651858.CD008265.pub2.

Endoscopic release for carpal tunnel syndrome

Haris S Vasiliadis  1 , Petros Georgoulas, Ian Shrier, Georgia Salanti, Rob J P M Scholten
Affiliations
Meta-Analysis

Endoscopic release for carpal tunnel syndrome

Haris S Vasiliadis et al. Cochrane Database Syst Rev. .

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity. It is caused by increased pressure on the median nerve between the transverse carpal ligament and the carpal bones. Surgical treatment consists of the release of the nerve by cutting the transverse carpal ligament. This can be done either with an open approach or endoscopically.

Objectives: To assess the effectiveness and safety of the endoscopic techniques of carpal tunnel release compared to any other surgical intervention for the treatment of CTS. More specifically, to evaluate the relative impact of endoscopic techniques in relieving symptoms, producing functional recovery (return to work and return to daily activities) and reducing complication rates.

Search methods: This review fully incorporates the results of searches conducted up to 5 November 2012, when we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE. There were no language restrictions. We reviewed the reference lists of relevant articles and contacted trial authors. We also searched trial registers for ongoing trials. We performed a preliminary screen of searches to November 2013 to identify any additional recent publications.

Selection criteria: We included any randomised controlled trials (RCTs) and quasi-RCTs comparing endoscopic carpal tunnel release (ECTR) with any other surgical intervention for the treatment of CTS.

Data collection and analysis: We used standard methodological procedures expected by the Cochrane Collaboration.

Main results: Twenty-eight studies (2586 hands) were included. Twenty-three studies compared ECTR to standard open carpal tunnel release (OCTR), five studies compared ECTR with OCTR using a modified incision, and two studies used a three-arm design to compare ECTR, standard OCTR and modified OCTR.At short-term follow-up (three months or less), only one study provided data for overall improvement. We found no differences on the Symptom Severity Scale (SSS) (scale zero to five) (five studies, standardised mean difference (SMD) -0.13, 95% CI -0.47 to 0.21) or on the Functional Status Scale (FSS) (scale zero to five) (five studies, SMD -0.23, 95% CI -0.60 to 0.14) within three months postoperatively between ECTR and OCTR. Pain scores favoured ECTR over conventional OCTR (two studies, SMD -0.41, 95% CI -0.65 to -0.18). No difference was found between ECTR and OCTR (standard and modified) when pain was assessed on non-continuous dichotomous scales (five studies, RR 0.69, 95% CI 0.33 to 1.45). Also, no difference was found in numbness (five studies, RR 1.14; 95% CI 0.76 to 1.71). Grip strength was increased after ECTR when compared with OCTR (six studies, SMD 0.36, 95% CI 0.09 to 0.63). This corresponds to a mean difference (MD) of 4 kg (95% CI 1 to 6.9 kg) when compared with OCTR, which is probably not clinically significant.In the long term (more than three months postoperatively) there was no significant difference in overall improvement between ECTR and OCTR (four studies, RR 1.04, 95% CI 0.95 to 1.14). SSS and FSS were also similar in both treatment groups (two studies, MD 0.02, 95% CI -0.18 to 0.22 for SSS and MD 0.01, 95% CI -0.14 to 0.16 for FSS). ECTR and OCTR did not differ in the long term in pain (six studies, RR 0.88, 95% CI 0.57 to 1.38) or in numbness (four studies, RR 0.64, 95% CI 0.31 to 1.35). Results from grip strength testing favoured ECTR (two studies, SMD 1.13, 95% CI 0.56 to 1.71), corresponding to an MD of 11 kg (95% CI 6.2 to 18.81). Participants treated with ECTR returned to work or daily activities eight days earlier than participants treated with OCTR (four studies, MD -8.10 days, 95% CI -14.28 to -1.92 days).Both treatments were equally safe with only a few reports of major complications (mainly with complex regional pain syndrome) (15 studies, RR 1.00, 95% CI 0.38 to 2.64).ECTR resulted in a significantly lower rate of minor complications (18 studies, RR 0.55, 95% CI 0.38 to 0.81), corresponding to a 45% relative drop in the probability of complications (95% CI 62% to 19%). ECTR more frequently resulted in transient nerve problems (ie, neurapraxia, numbness, and paraesthesiae), while OCTR had more wound problems (ie, infection, hypertrophic scarring, and scar tenderness). ECTR was safer than OCTR when the total number of complications were assessed (20 studies, RR 0.60, 95% CI 0.40 to 90) representing a relative drop in the probability by 40% (95% CI 60% to 10%).Rates of recurrence of symptoms and the need for repeated surgery were comparable between ECTR and OCTR groups.The overall risk of bias in studies that contribute data to these results is rather high; fewer than 25% of the included studies had adequate allocation concealment, generation of allocation sequence or blinding of the outcome assessor.The quality of evidence in this review may be considered as generally low. Five of the studies were presented only as abstracts, with insufficient information to judge their risk of bias. In selection bias, attrition bias or other bias (baseline differences and financial conflict of interest) we could not reach a safe judgement regarding a high or low risk of bias. Blinding of participants is impossible due to the nature of interventions.We identified three further potentially eligible studies upon updating searches just prior to publication. These compared ECTR with OCTR (two studies) or mini-open carpal tunnel release (one study) and will be fully assessed when we update the review.

Authors' conclusions: In this review, with support from low quality evidence only, OCTR and ECTR for carpal tunnel release are about as effective as each other in relieving symptoms and improving functional status, although there may be a functionally significant benefit of ECTR over OCTR in improvement in grip strength. ECTR appears to be associated with fewer minor complications compared to OCTR, but we found no difference in the rates of major complications. Return to work is faster after endoscopic release, by eight days on average. Conclusions from this review are limited by the high risk of bias, statistical imprecision and inconsistency in the included studies.

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Conflict of interest statement

HSV received travel support from manufacturer of instrumentation for mini‐open and endoscopic release to attend orthopaedic conference. Additionally, he is the Principal Investigator in an ongoing RCT comparing ECTR versus mini‐open carpal tunnel release.

PG, GS, IS, RS: none known.

Figures

1
1
Study flow diagram (does not include the results of search in November 2013, which will be fully assessed in the next update).
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study. Green (+) = low risk of bias; yellow (?) = unclear risk of bias; red (‐) = high risk of bias
3
3
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.3 Symptom Severity Scale (Levine) at 3 months or less.
4
4
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.4 Function Status Scale at 3 months or less.
5
5
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.10 Grip strength at 3 months or less.
6
6
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.24 Minor complications.
7
7
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.25 Total complications.
8
8
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.6 Pain at 3 months or less (corr = 0.9).
9
9
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.8 Pain (dichotomous) at 3 months or less.
10
10
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.9 Numbness (dichotomous) at 3 months or less.
11
11
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.19 Grip strength at more than 3 months.
12
12
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.20 Time to return to work.
13
13
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.21 Recurrence.
14
14
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.22 Reoperations.
15
15
Forest plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.23 Major complications.
16
16
Funnel plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.21 Recurrence.
17
17
Funnel plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.22 Reoperations.
18
18
Funnel plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.23 Major complications.
19
19
Funnel plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.24 Minor complications.
20
20
Funnel plot of comparison: 1 Endoscopic versus open or mini‐open carpal tunnel release, outcome: 1.25 Total complications.
1.1
1.1. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 1 Overall improvement at 3 months or less.
1.2
1.2. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 2 Overall satisfaction at 3 months or less.
1.3
1.3. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 3 Symptom Severity Scale (Levine) at 3 months or less.
1.4
1.4. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 4 Function Status Scale at 3 months or less.
1.5
1.5. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 5 Pain at 3 months or less (corr = 0.5).
1.6
1.6. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 6 Pain at 3 months or less (corr = 0.9).
1.7
1.7. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 7 Pain at 3 months or less (corr = 0.1).
1.8
1.8. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 8 Pain (dichotomous) at 3 months or less.
1.9
1.9. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 9 Numbness (dichotomous) at 3 months or less.
1.10
1.10. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 10 Grip strength at 3 months or less.
1.11
1.11. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 11 Overall improvement at more than 3 months.
1.12
1.12. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 12 Overall satisfaction at more than 3 months.
1.13
1.13. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 13 Symptom Severity Scale (Levine) at more than 3 months.
1.14
1.14. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 14 Function Status Scale at more than 3 months.
1.15
1.15. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 15 Pain at more than 3 months.
1.16
1.16. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 16 Pain (dichotomous) at more than 3 months.
1.17
1.17. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 17 Numbness at more than 3 months.
1.18
1.18. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 18 Numbness (dichotomous) at more than 3 months.
1.19
1.19. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 19 Grip strength at more than 3 months.
1.20
1.20. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 20 Time to return to work.
1.21
1.21. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 21 Recurrence.
1.22
1.22. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 22 Reoperations.
1.23
1.23. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 23 Major complications.
1.24
1.24. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 24 Minor complications.
1.25
1.25. Analysis
Comparison 1 Endoscopic versus open or mini‐open carpal tunnel release, Outcome 25 Total complications.
2.1
2.1. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 1 Overall satisfaction at 3 months or less.
2.2
2.2. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 2 Overall improvement at 3 months or less.
2.3
2.3. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 3 Symptom Severity Scale (Levine) at 3 months or less.
2.4
2.4. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 4 Function Status Scale at 3 months or less.
2.5
2.5. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 5 Pain at 3 months or less (corr = 0.5).
2.6
2.6. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 6 Pain at 3 months or less (corr = 0.1).
2.7
2.7. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 7 Pain at 3 months or less (corr = 0.9).
2.8
2.8. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 8 Pain (dichotomous) at 3 months or less.
2.9
2.9. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 9 Numbness (dichotomous) at 3 months or less.
2.10
2.10. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 10 Grip strength at 3 months or less.
2.11
2.11. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 11 Overall satisfaction at more than 3 months.
2.12
2.12. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 12 Overall improvement at more than 3 months.
2.13
2.13. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 13 Symptom Severity Scale (Levine) at more than 3 months.
2.14
2.14. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 14 Function Status Scale at more than 3 months.
2.15
2.15. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 15 Pain at more than 3 months.
2.16
2.16. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 16 Pain (dichotomous) at more than 3 months.
2.17
2.17. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 17 Numbness at more than 3 months.
2.18
2.18. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 18 Numbness (dichotomous) at more than 3 months.
2.19
2.19. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 19 Grip strength at more than 3 months.
2.20
2.20. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 20 Time to return to work.
2.21
2.21. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 21 Recurrence.
2.22
2.22. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 22 Reoperations.
2.23
2.23. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 23 Major complications.
2.24
2.24. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 24 Minor complications.
2.25
2.25. Analysis
Comparison 2 One‐ or two‐portal endoscopic versus open and mini‐open carpal tunnel release, Outcome 25 Total complications.
3.1
3.1. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 1 Symptom Severity Scale (Levine) at 3 months or less.
3.2
3.2. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 2 Function Status Scale at 3 months or less.
3.3
3.3. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 3 Pain at 3 months or less (corr = 0.5).
3.4
3.4. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 4 Pain at 3 months or less (corr = 0.1).
3.5
3.5. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 5 Pain at 3 months or less (corr = 0.9).
3.6
3.6. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 6 Grip strength at 3 months or less.
3.7
3.7. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 7 Pain (dichotomous) at more than 3 months.
3.8
3.8. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 8 Numbness (dichotomous) at more than 3 months.
3.9
3.9. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 9 Time to return to work.
3.10
3.10. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 10 Reoperations.
3.11
3.11. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 11 Major complications.
3.12
3.12. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 12 Minor complications.
3.13
3.13. Analysis
Comparison 3 Sensitivity analysis 1 (low risk of bias for incomplete outcome data), Outcome 13 Total complications.
4.1
4.1. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 1 Overall improvement at more than 3 months.
4.2
4.2. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 2 Symptom Severity Scale (Levine) at 3 months or less.
4.3
4.3. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 3 Pain at 3 months or less (corr = 0.5).
4.4
4.4. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 4 Pain at 3 months or less (corr = 0.1).
4.5
4.5. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 5 Pain at 3 months or less (corr = 0.9).
4.6
4.6. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 6 Pain (dichotomous) at 3 months or less.
4.7
4.7. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 7 Pain (dichotomous) at more than 3 months.
4.8
4.8. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 8 Numbness (dichotomous) at 3 months or less.
4.9
4.9. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 9 Numbness (dichotomous) at more than 3 months.
4.10
4.10. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 10 Function Status Scale at 3 months or less.
4.11
4.11. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 11 Grip strength at 3 months or less.
4.12
4.12. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 12 Recurrence.
4.13
4.13. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 13 Reoperations.
4.14
4.14. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 14 Major complications.
4.15
4.15. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 15 Minor complications.
4.16
4.16. Analysis
Comparison 4 Sensitivity analysis 2 (exclusion of inappropriate adjustment for bilateral involvement), Outcome 16 Total complications.
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References

References to studies included in this review

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    1. Tian Y, Zhao H, Wang T. Prospective comparison of endoscopic and open surgical methods for carpal tunnel syndrome. Chinese Medical Sciences Journal 2007;22(2):104‐7. [PUBMED: 17763582] - PubMed
Trumble 2002 {published data only}
    1. Trumble TE, Diao E, Abrams RA, Gilbert‐Anderson MM. Single‐portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. Journal of Bone & Joint Surgery. American Volume 2002;84‐A(7):1107‐15. [PUBMED: 12107308] - PubMed
Tüzüner 2008 {published data only}
    1. Tüzüner S, Inceoglu S, Bilen FE. Median nerve excursion in response to wrist movement after endoscopic and open carpal tunnel release. Journal of Hand Surgery 2008;33(7):1063‐8. [PUBMED: 18762098] - PubMed
Werber 1996 {published data only}
    1. Werber KD, Braver RB, Richtarsky I. Endoscopic carpal tunnel release versus open procedure: a prospective randomized study. Journal of Hand Surgery. British Volume 1996;21 B Suppl 1:11‐2.
Westphal 2000 {published data only}
    1. Westphal KP, Bayat M, Wustner‐Hofmann M, Hofmann A. Course of clinical symptoms before and after surgical decompression in carpal tunnel surgery. Lymphologie in Forschung Und Praxis 2000;4(2):69‐73. [EMBASE: 2002067974]
Wong 2003 {published data only}
    1. Wong KC, Hung LK, Ho PC, Wong JM. Carpal tunnel release. A prospective, randomised study of endoscopic versus limited‐open methods. Journal of Bone & Joint Surgery. British Volume 2003;85(6):863‐8. [PUBMED: 12931807] - PubMed

References to studies excluded from this review

Atroshi 2007 {published data only}
    1. Atroshi I, Gummesson C, McCabe SJ, Ornstein E. The SF‐6D health utility index in carpal tunnel syndrome. Journal of Hand Surgery. European Volume 2007;32(2):198‐202. [PUBMED: 17223234] - PubMed
Bal 2008 {published data only}
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Cellocco 2005 {published data only}
    1. Cellocco P, Rossi C, Bizzarri F, Patrizio L, Costanzo G. Mini‐open blind procedure versus limited open technique for carpal tunnel release: a 30‐month follow‐up study. Journal of Hand Surgery 2005;30(3):493‐9. [PUBMED: 15925158] - PubMed
Dimitriou 1997 {published data only}
    1. Dimitriou GG, Kapetanos G, Koukou C, Symeonides PP. Bilateral carpal tunnnel syndrome. Open vs endoscopic release. Journal of Hand Surgery. British and European Volume 1997;22 Suppl 1:59.
Flores 2005 {published data only}
    1. Flores LP. [Endoscopic carpal tunnel release: a comparative study to the conventional open technique] [Descompressão do túnel do carpo pela técnica endoscópica: estudo comparativo com a técnica convencional aberta]. Arquivos de Neuro‐Psiquiatria 2005;63(3A):637‐42. [PUBMED: 16172714] - PubMed
Futami 1995 {published data only}
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Hallock 1995 {published data only}
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Katz 1994a {published data only}
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Katz 1994b {published data only}
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Lorgelly 2005 {published data only}
    1. Lorgelly PK, Dias JJ, Bradley MJ, Burke FD. Carpal tunnel syndrome, the search for a cost‐effective surgical intervention: a randomised controlled trial. Annals of the Royal College of Surgeons of England 2005;87(1):36‐40. [PUBMED: 15720906] - PMC - PubMed
Povlsen 1997 {published data only}
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Uchiyama 2002 {published data only}
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Uchiyama 2004 {published data only}
    1. Uchiyama S, Yasutomi T, Fukuzawa T, Nakagawa H, Kamimura M, Miyasaka T. Median nerve damage during two‐portal endoscopic carpal tunnel release. Clinical Neurophysiology 2004;115(1):59‐63. [PUBMED: 14706469] - PubMed
Vasiliadis 2010 {published data only}
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Worseg 1996 {published data only}
    1. Worseg AP, Kuzbari R, Korak K, Höcker K, Wiederer C, Tschabitscher M, et al. Endoscopic carpal tunnel release using a single‐portal system. British Journal of Plastic Surgery 1996;49(1):1‐10. [PUBMED: 8705095] - PubMed
Zhao 2004 {published data only}
    1. Zhao H, Zhao Y, Tian Y, Yang B, Qiu GX. [Comparison of endoscopic versus open surgical treatment of carpal tunnel syndrome]. Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 2004;26(6):657‐60. [PUBMED: 15663227] - PubMed

References to studies awaiting assessment

Aslani 2012 {published data only}
    1. Aslani HR, Alizadeh K, Eajazi A, Karimi A, Karimi MH, Zaferani Z, et al. Comparison of carpal tunnel release with three different techniques. Clinical Neurology and Neurosurgery 2012;114(7):965‐8. - PubMed
Braga 1996 {published data only}
    1. Braga‐Siva J, Fontes Neto P, Foucher G, Fridman M. Postoperative strength after surgical release of the carpal tunnel: A randomized prospective study. Revista Brasileira De Ortopedia 1996;31(4):355‐7.
Ejiri 2012 {published data only}
    1. Soichi E, Shin‐ichi K, Masato M, Yasufumi S, Ryoichi K, Shin‐ichi K. Short‐term results of endoscopic (Okutsu method) versus palmar incision open carpal tunnel release: a prospective randomized controlled trial. Fukushima Journal of Medical Science 2012;58(1):49‐59. - PubMed
Kang 2013 {published data only}
    1. Kang HJ, Koh IH, Lee TJ, Choi YR. Endoscopic carpal tunnel release is preferred over mini‐open despite similar outcome: a randomized trial. Clinical Orthopaedics and Related Research 2013;471(5):1548‐54. - PMC - PubMed
Ugurlu 2009 {published data only}
    1. Ugurlu MO, Öztürk AM, Tecimel O, Kiliçaslan K, Sener EE, Tosun N. The comparison of endoscopic and open carpal tunnel surgery results according to functional scores and cost effectiveness of treatment [Endoskopik ve Açik Teknikle Yapilan Karpal Tünel Cerrahi Sonuçlarinin Fonksiyonel Sonuçlar ve Tedavi Maliyeti Açisindan Karsilastirilmasi]. Turkiye Klinikleri Journal of Medical Sciences 2009;29(2):469‐73.

References to ongoing studies

NCT00880295 {unpublished data only}
    1. NCT00880295. Patient outcomes with endoscopic versus open carpal tunnel release. http://clinicaltrials.gov/show/NCT00880295 (accessed 28 March 2013).
NCT01756820 {unpublished data only}
    1. NCT01756820. Single‐portal endoscopic carpal tunnel release versus Knifelight for carpal tunnel syndrome. A randomized control trial (CTS‐HV). http://clinicaltrials.gov/ct2/show/NCT01756820 (accessed 28 March 2013).

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References to other published versions of this review

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Publication types