Time to recovery following open and endoscopic carpal tunnel decompression: meta-analysis

Abstract

Background: Carpal tunnel release (CTR) can be performed using either an open or endoscopic approach. The patient recovery trajectories remain poorly understood. This study aimed to define and compare patient-reported recovery following unilateral open and endoscopic CTR.

Methods: A PRISMA-compliant, preregistered (CRD42023427718) systematic review was conducted, searching PubMed, Embase, and Cochrane databases on 4 July 2023 and 21 August 2024. Studies were included if they reported recovery data (patient-reported outcome measures (PROMs)) at predefined time points for adults undergoing unilateral CTR. Boston Carpal Tunnel Questionnaire and Quick Disabilities of Arm, Shoulder, and Hand scores were extracted. Standardized mean change (SMC) scores from baseline were pooled using random-effects meta-analysis. An innovative modification of the National Institutes of Health quality assessment tools was used to evaluate the risk of bias.

Results: In all, 49 studies were included (4546 participants included in the analysis; 3137 open CTR, 1409 endoscopic CTR). Both approaches improved PROM scores over 12 weeks, with early (4-week) outcomes strongly correlating (>0.89) with later (12-week) outcomes. Symptoms continued improving up to 104 weeks. At 1 week, open CTR showed symptomatic deterioration (SMC 10.29; 95% confidence interval (c.i.) 6.35 and 14.21 respectively), comparatively, endoscopic CTR demonstrated an improvement (SMC -2.83; 95% c.i. -7.80 and 2.14 respectively). By 2 weeks, symptom severity remained slightly worse in open CTR, but confidence intervals overlapped from week 3 and thereafter open CTR showed greater symptomatic improvement. Most studies had a high risk of bias and measured outcomes too infrequently for a granular comparison.

Conclusions: Patient-reported recovery trajectories for CTR can inform patient counselling and future research. Endoscopic CTR may result in fewer symptoms in the first 2 weeks, but open CTR may offer comparable or potentially greater improvement thereafter. Future trials with high-frequency PROM capture should prioritize early (first 3 weeks) and long-term (≥24 weeks) outcomes.

Keywords: orthopaedics; plastic surgery.

Fig. 1

Study selection flow diagram BCTQ, Boston Carpal Tunnel Questionnaire; PROM, patient-reported outcome measure; SMC, standardized mean change.

Fig. 2

Change in BCTQ score after open and endoscopic carpal tunnel release over time Standardized mean change estimates (points) with smooth interpolation with LOESS function (lines). A decrease in score over time indicates recovery to a plateau. Each line represents a study arm. BCTQ, Boston Carpal Tunnel Questionnaire.

Fig. 3

Cumulative SMC in BCTQ scores for endoscopic and open carpal tunnel release In this plot, each point represents the pooled SMC estimate from the 16 different meta-analyses covering weeks 1–52. Not every study will have contributed data to each point. Shaded areas represent 95% confidence intervals. The lower the score, the better the clinical symptoms. The steeper the gradient, the faster the recovery at group level. BCTQ, Boston Carpal Tunnel Questionnaire; SMC, standardized mean change.