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. 2024 Apr 1;25(1):251.
doi: 10.1186/s12891-023-07151-w.

Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision

Ryo Nakamichi  1 , Taichi Saito  2 , Yasunori Shimamura  3 , Masanori Hamada  1 , Keiichiro Nishida  3 , Toshifumi Ozaki  3
Affiliations

Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision

Ryo Nakamichi et al. BMC Musculoskelet Disord. .

Abstract

Background: The purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy.

Methods: Sixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient's satisfaction with the surgery.

Results: In the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7).

Conclusions: ECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.

Keywords: Carpal tunnel syndrome; Endoscopy; Mini-open; Patient-oriented evaluation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Surgical techniques of Mini-incision Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR). (a) A representative view of mini-OCTR. The length of the skin incision is 1.5 cm. (b) A representative view of ECTR. The length of the skin incision is 1 cm
Fig. 2
Fig. 2
The results of the nerve conduction velocity tests. (a) Distal latency of each group preoperatively (Pre-op) and 6 months postoperatively (Post-6 M). Blue dots: mini-OCTR, Red dots: ECTR. (b) Sensory nerve conduction velocity (SCV) of each group preoperatively (Pre-op) and 6 months postoperatively (Post-6 M). Blue dots: mini-OCTR, Red dots: ECTR. ** P < 0.01, *** P < 0.001
Fig. 3
Fig. 3
The results of DASH (a) and pain VAS (b). Blue dots: Preoperatively (Pre-op), Red dots: 1 month postoperatively (Post-1 M), Green dots: 3 months postoperatively (Post-3 M), Purple dots: 6 months postoperatively (Post-6 M).** P < 0.01, *** P < 0.001
Fig. 4
Fig. 4
The results of cosmetic VAS. Blue dots: Preoperatively (Pre-op), Red dots: 1 month postoperatively (Post-1 M), Green dots: 3 months postoperatively (Post-3 M), Purple dots: 6 months postoperatively (Post-6 M). ** P < 0.01, *** P < 0.001, **** P < 0.0001
Fig. 5
Fig. 5
The results of Patient Satisfaction Score. The evaluation consists of five levels (5 = Excellent, 4 = Very good, 3 = Good, 2 = Fair, and 1 = Poor)
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