Long-term outcome after carpal tunnel decompression - a prospective randomised study of the Indiana Tome and a standard limited palmar incision

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

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.

A five-year retrospective cohort study of carpal tunnel surgery complications in an Australian population

BACKGROUND

Carpal tunnel syndrome is a common compressive neuropathy. There is a lack of comprehensive studies evaluating carpal tunnel release (CTR) complications in Australia. This study aimed to evaluate complication rates associated with open and endoscopic CTR in an Australian population, and to identify associated risk factors.

METHODS

Retrospective cohort study of 1287 CTR from 2015 to 2020. Methods of release were endoscopic, open and surgery concomitant with synovectomy or other. Outcomes included wound infection, dehiscence, nerve injury, complex regional pain syndrome, incomplete release, and re-operation. Statistical analysis included Chi-squared test, Fisher's exact test, Odds ratio and logistic regression.

RESULTS

There were 71 total complications (5.5%), including 35 Clavien-Dindo IIIb complications. There was no difference in complication rates for endoscopic (3.3%) versus open (8.3%) CTR (P = 0.18). The overall rate of complications was higher in CTR with concomitant surgery (8.5%) compared to CTR alone (5.2%), though this was not statistically significant (P = 0.058). There was no association between rates of complications and immune suppression (p = 0.55), rheumatoid disease (P = 0.61), or smoking status (P = 0.72). Diabetes mellitus was associated with an increased risk of Clavien-Dindo IIIb complications (P = 0.028, OR 2.15, 95% CI 1.07-4.32). There was no association between surgical experience and complication rate (P = 0.55).

CONCLUSION

Open and endoscopic CTR surgeries have similar rates of complications. Diabetes is associated with higher rates of Clavien-Dindo IIIb complications. Identification of high-risk patients allows for the application of risk-mitigation strategies in the perioperative setting.

Mini-open carpal tunnel release: technique, feasibility and clinical outcome compared to the conventional procedure in a long-term follow-up

We sought to evaluate the findings of our anatomically landmarks based mini-open procedure (MCTR) through a palmar approach and to compare its outcome and practicability to the conventional method (OCTR). The study consisted of 100 matched patients (n = 50 MCTR, n = 50 OCTR) with a minimum follow-up of three years. The outcome was characterized via the Disabilities of Arm, Shoulder and Hand Score (DASH), Symptom Severity Scale (SSS), Functional Status Scale (FSC), and Visual Analogue Scale (VAS). All adverse events were observed. An alpha of 0.05 and a confidence level of 95% were set for statistical analyses. Both techniques showed comparable functional results in a long-term period (mean follow-up MCTR: 60 months and OCTR: 54 months). MCTR versus OCTR at mean: DASH: 4.6/8.3 (p = 0.398), SSS: 1.3/1.2 (p = 0.534), FSC: 1.3/1.2 (p = 0.617), VAS: 0.4/0.7 (p = 0.246). The MCTR convinced through a lower rate of scar sensibility (MCTR: 0% vs. OCTR: 12%, 0/50 vs. 6/50; p = 0.007) and pillar pain, as well as a shortened recovery period and surgical time relative to the OCTR. Low complication rates were observed in both groups, no recurrences had to be documented. The MCTR procedure revealed a similar good clinical outcome as the conventional technique. MCTR is a minimally-invasive, reliable, fast and simple procedure with an obvious benefit regarding scar sensibility.

A Systematic Review of Randomised Control Trials Evaluating the Efficacy and Safety of Open and Endoscopic Carpal Tunnel Release

INTRODUCTION

Carpal tunnel syndrome is the most prevalent form of nerve compression syndrome of the upper limb; therefore, it is of clinical significance to critique treatment methods. There is an ongoing debate amongst clinicians as to which surgical method-open or endoscopic carpal tunnel release-provides better overall symptom relief and faster recovery time. This systematic review aimed to investigate the evidence from randomised control trials to evaluate the effectiveness and safety of open and endoscopic carpal tunnel release surgery.

METHODS

Database searches were carried out to identify literature. An inclusion and exclusion criteria was applied to only include randomised control trials which compared open and endoscopic surgery. Publications were then selected according to PRISMA guidelines, risk of bias was assessed and patient outcome was assessed.

RESULTS

Twenty-three studies were selected for this systematic review. It was found that for improvement to grip strength and symptom severity, the endoscopic group had more significant improvement in the short term, resulting in a quicker return to work time compared to the open group. The complication rate for both intervention groups was low despite more severe and irreversible complications such as prolonged pain and wound infections being observed in the open group; however, the endoscopic group reported a higher risk of needing repeat surgery.

CONCLUSION

The quicker recovery time, improved cosmetic result and less severe complications observed with the endoscopic technique suggest that it should be used more often. However, this review found no convincing evidence of a significantly superior technique in the long term.

Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review

OBJECTIVE

To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS).

DATA SOURCES

The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.

STUDY SELECTION

Two reviewers independently applied the inclusion criteria to select potential studies.

DATA EXTRACTION

Two reviewers independently extracted the data and assessed the methodologic quality.

DATA SYNTHESIS

A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found.

CONCLUSIONS

Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- (2-3 days) favored a long-duration (9-14 days) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term. More research regarding the optimal timing of surgery for CTS is needed.

Intraindividual comparison between open and endoscopic release in bilateral carpal tunnel syndrome: a meta-analysis of randomized controlled trials

PURPOSE

This study evaluated functional outcomes and safety after endoscopic and open bilateral carpal tunnel syndrome release in opposite hands of the same patients through a meta-analysis of randomized controlled trial data.

MATERIALS AND METHODS

Randomized controlled trials involving both methods in opposite hands of patients with bilateral carpal tunnel syndrome were identified via a systematic review of PUBMED and EMBASE.

RESULTS

Relative risks (RRs) and 95% confidence intervals (CIs) from five randomized controlled trials involving 142 patients with bilateral carpal tunnel syndrome were calculated using fixed- or random-effect methods, with a length of follow-up from 24 to 52 weeks after surgery. Compared with open release, endoscopic carpal tunnel release was associated with significantly better Boston Carpal Tunnel Questionnaire functional status scores (mean difference [MD] = 0.13, 95% confidence interval [CI] [0.02 - 0.25]; P = 0.02), but not symptom severity scores (RR = 0.06, 95% CI [-0.15 to 0.04]; P = 0.25). Endoscopic release required a longer operative time, but the procedures did not differ significantly in visual analog scale pain scores (MD = 0.02, 95% CI [-0.08 to 0.11]; P = 0.75), handgrip strength (MD = 0.17, 95% CI [-2.03 to 2.37]; P = 0.88), digital sensibility static two-point discrimination (MD = 0.34, 95% CI [-0.03 to 0.70]; P = 0.07), or complication rates (MD = 0.01, 95% CI [-0.02 to 0.05], P = 0.47).

CONCLUSION

From intraindividual evidence, endoscopic release promoted better recovery of daily life functions than open release, but required a longer operative time. The procedures provided similar symptom relief and hand strength and sensibility recovery, and were safe for patients with carpal tunnel syndrome.

Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials

The objective of this study is to do a meta-analysis of the literature and compare the safety and efficacy of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) for idiopathic carpal tunnel syndrome (CTS). A comprehensive literature search of the electronic databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register was undertaken for randomized studies reporting carpal tunnel syndrome treated with ECTR or OCTR. The quality of randomized trials was critically assessed. Pooled relative risk (RR) and 95% confidence intervals (CIs) for safety and efficacy outcome variables were calculated by fixed-effect or random-effect methods with RevMan v.5.1 provided by the Cochrane Collaboration. A total of 13 randomized trials were included by total retrieve and riddling. The results of our meta-analysis showed no significant difference in the overall complication rate (RR = 1.34, 95% CI [0.74, 2.43], P = 0.34), subjective satisfaction (RR = 1.0, 95% CI [0.93, 1.08], P = 0.92), time to return to work (mean difference = −3.52 [−8.15, 1.10], P = 0.14), hand grip and pinch strength, and the operative time (mean difference = −1.89, 95% CI [−5.84, 2.06]) between patients in the ECTR and OCTR groups (P = 0.16, 0.70, and 0.35, respectively). The rate of hand pain (RR = 0.73, 95% CI [0.53, 0.93], P = 0.02) in the ECTR group was significantly lower than that in the OCTR group. ECTR treatment seemed to cause more reversible postoperative nerve injuries as compared with OCTR (RR = 2.38, 95% CI [0.98, 5.77], P = 0.05). Although ECTR significantly reduced postoperative hand pain, it increased the possibility of reversible postoperative nerve injury in patients with idiopathic CTS. No statistical difference in the overall complication rate, subjective satisfaction, the time to return to work, postoperative grip and pinch strength, and operative time was observed between the two groups of patients.

Prospective randomized comparison of single-incision and two-incision carpal tunnel release outcomes

BACKGROUND

This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release (CTR).

METHODS

From 2008 to 2009, patients with isolated carpal tunnel syndrome were randomized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center. Pre-operatively, participants completed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ), as well as grip and pinch strength and Semmes-Weinstein monofilament sensation testing. At 2 weeks, 6 weeks and at least 6 months post-operatively, these measurements were repeated along with assessment of scar tenderness and pillar pain. Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson's correlations. Significance was set at p = 0.05.

RESULTS

There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores, BWCTQ scores, grip strength, pinch strength, scar tenderness, or pillar pain. The only statistically significant difference was improved sensation by Semmes-Weinstein in the single-incision group in the second finger at 6 weeks post-operatively and in the third finger at 6 months post-operatively.

CONCLUSIONS

The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period. However, there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6+ months post-operatively.

Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial

BACKGROUND

The decision to perform endoscopic versus the mini-open carpal tunnel release technique is most likely left to surgeons rather than patients with idiopathic carpal tunnel syndrome.

QUESTIONS/PURPOSES

We hypothesized that (1) at 3 months after surgery, the subjective outcomes of endoscopic release, performed on one hand, and mini-incision release, performed on the other, would not differ in patients with bilateral carpal tunnel syndrome; however, (2) each patient would likely prefer one technique over the other for specific reasons.

METHODS

Fifty-two patients with bilateral carpal tunnel syndrome had one hand randomized to undergo endoscopic release and the other to undergo mini-incision release. Each patient was assessed with the Boston Carpal Tunnel Questionnaire (BCTQ) and DASH preoperatively and at each followup. Three months after surgery, the patients commented on which technique they preferred and completed a questionnaire regarding the reasons for not preferring the other technique.

RESULTS

The mean BCTQ symptom/function score and DASH improved similarly in the endoscopic release group and the mini-incision release group. Thirty-four patients preferred endoscopic release and 13 preferred the mini-incision technique. Scar or pillar pain was the most commonly cited factor in not preferring either technique followed by postoperative pain for the open technique and transient worsening of symptoms for the endoscopic technique.

CONCLUSIONS

Despite similar improvements in BCTQ and DASH scores after endoscopic and open techniques at 3 months postoperatively, the majority of our patients preferred the endoscopic technique. The most concerning reason for not preferring the other technique was scar or pillar pain.

Ultrasound-guided carpal tunnel release using the manos CTR system

PURPOSE

Ultrasound (US) has been used in the management of carpal tunnel syndrome since the 1980s. The first report of US-guided carpal tunnel release (CTR) was published in 1997, with cadaver and clinical reports confirming the safe navigation of surgical tools with US for division of the transverse carpal ligament. The MANOS CTR device was recently reported as a minimally invasive tool for CTR, and may be well suited for use with US guidance.

PATIENTS AND METHODS

The authors report three cases of US-guided CTR using the MANOS CTR device. The MANOS device was inserted in a blunt configuration into the safe zone, and the cutting surface was deployed with a thumb-activated trigger that simultaneously ejected a sharp through the palm. The transverse carpal ligament was divided safely and confirmed with US.

RESULTS

US allowed for clear identification of the median nerve, safe zones, transverse carpal ligament, and the MANOS CTR device in relation to all pertinent structures of the carpal tunnel. Complete division of the transverse carpal ligament was confirmed in all three cases. There were no median nerve, vessel, tendon injuries, or chronic regional pain syndrome in any of the three cases.

CONCLUSIONS

US-guided CTR with the MANOS CTR device appears to be a safe technique and successful in confirming complete release.

Minimally invasive ultrasound-guided carpal tunnel release: a cadaver study

BACKGROUND

Carpal tunnel syndrome is a common condition frequently requiring surgical intervention. We describe a new minimally invasive surgical technique for carpal tunnel release utilizing ultrasound (US) visualization.

METHODS

The technique was performed on 20 fresh frozen cadaver specimens. A surgical metallic probe with a "U"-shaped trough and upward curved distal tip was precisely positioned in the carpal tunnel with US guidance followed by division of the flexor retinaculum (FR) with a "V"-shaped scalpel.

RESULTS

Complete division of the FR was confirmed by US. Dissection performed on the specimens confirmed complete release of FR and absence of neurovascular injury. The distance from the division of the FR to these structures, the "safety margins," was measured.

CONCLUSIONS

This new technique for carpal tunnel release appears to combine the safety and efficacy of open carpal tunnel surgery with the advantages of the minimally invasive techniques.

Long-term outcomes of carpal tunnel release: a critical review of the literature

BACKGROUND

Carpal tunnel release (CTR) is widely accepted as an effective surgical treatment method for idiopathic carpal tunnel syndrome. While the short-term literature is well substantiated, the "long-term" literature has rarely exceeded 2 years of follow-up, which may be inadequate for a chronic and potentially recurring disease such as carpal tunnel syndrome.

METHODS

An English language literature search for long-term outcomes research on carpal tunnel release was made. Long-term is defined as 2 years or more after surgery.

RESULTS

CTR is a highly effective procedure, but important aspects remain poorly understood, including recurrence and existing electromyographic data. Some study design issues exist with the current literature.

CONCLUSIONS

Further high-quality research is needed.

Comparison of longitudinal open incision and two-incision techniques for carpal tunnel release

PURPOSE

This study analyzes the long-term postoperative symptoms and functional outcomes of patients who underwent either traditional open (single-incision) or 2-incision carpal tunnel release (CTR). Because 2-incision CTR preserves the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences, it may account for fewer postoperative symptoms and improved functional recovery.

METHODS

A retrospective chart review identified patients who underwent either open or 2-incision CTR for isolated carpal tunnel syndrome between 2005 and 2008 by a single surgeon. Patients with a history of hand trauma or confounding comorbidities were excluded. We mailed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and a Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ) to all eligible participants. Data from the completed questionnaires were analyzed using independent t-tests and Pearson's correlation. Significance was set at p = .05.

RESULTS

A total of 82 patients (106 hands; 27 men and 55 women; mean age, 60.5 y) were eligible to participate. Of these, 51 patients (63 hands; 20 men and 31 women; mean age, 61.1 y) responded (62% response rate). The mean duration of follow-up was 22 months (range, 12-37 mo; SD 7.3 mo). The 2-incision group mean BWCTQ Symptom Severity Scale score (1.13, SD 0.25) was significantly lower than the open group mean Symptom Severity Scale score (1.54, SD 0.70, p = .001). The 2-incision group mean BWCTQ Functional Status Scale score (1.24, SD 0.51) was significantly lower than the open group mean Functional Status Scale score (1.71, SD 0.76, p = .008). The 2-incision group mean DASH score (5.10, SD 12.03) was significantly lower than the open group mean DASH score (16.28, SD 19.98, p = .01).

CONCLUSIONS

Patients treated with 2-incision CTR reported statistically significantly less severe long-term postoperative symptoms and improved functional status compared with patients treated with traditional open CTR. Future prospective studies with objective measures are needed to further investigate the difference in outcomes found between these 2 CTR techniques.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic III.

Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic review

OBJECTIVE

To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS).

DATA SOURCES

The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).

STUDY SELECTION

Two reviewers independently applied the inclusion criteria to select potential studies.

DATA EXTRACTION

Two reviewers independently extracted the data and assessed the methodologic quality.

DATA SYNTHESIS

A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of follow-up. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting.

CONCLUSIONS

Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.

Bilateral atypical muscles causing acute bilateral carpal tunnel syndrome in recreational climber

The occurrence of anomalous muscles in the hand is rare, and therefore the clinician frequently does not account for their existence when reaching the diagnosis and concluding the cause of carpal tunnel syndrome. This case report describes the highly unusual case of the occurrence of bilateral flexor digitorum superficialis muscles in a recreational climber who developed CTS following his intensive training schedule.

Minimally invasive carpal tunnel release

We prospectively compared the safety and effectiveness of mini-incision (group A) and a limited open technique (group B) for carpal tunnel release (CTR) in 185 consecutive patients operated between November 1999 and May 2001, with a 5-year minimum follow-up. Patients in Group A had a minimally invasive approach (<2 cm incision), performed using the KnifeLight (Stryker, Kalamazoo, Michigan) instrument. Patients in Group B had a limited longitudinal incision (3-4 cm). Patient status was evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire, administered preoperatively and at 19, 30, and 60 postoperative months. Mini-incision CTR showed advantages over standard technique in early recovery, pillar pain, and recurrence rate. The recovery period after mini-incision is shorter than after standard procedure.

Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial

PURPOSE

The purpose of this investigation was to extend the previously reported short-term randomized trial of open and endoscopic carpal tunnel release in patients with carpal tunnel syndrome (CTS) to compare outcomes 5 years after surgery.

METHODS

In a single-center randomized controlled trial, 128 patients (25 to 60 years) with clinically diagnosed and electrophysiologically confirmed idiopathic CTS were randomized immediately before surgery to open or 2-portal endoscopic release. The outcome measures included the validated CTS questionnaire's symptom severity and functional status scales (scored from 1 to 5) completed at baseline and 1 year postoperatively. At the extended follow-up of the trial 5 years after surgery, 2 patients had died and the other 126 participants (63 patients in each group) completed the CTS questionnaire.

RESULTS

At the 5-year follow-up no difference between the groups was found in the CTS symptom severity score. The mean (SD) score in the open group was 1.42 (0.7) and in the endoscopic group was 1.45 (0.7), and the mean difference in score change from baseline was 0.03 (95% confidence interval, -0.21 to 0.27). Between 1 year and 5 years postoperatively, the CTS symptom severity score had deteriorated by at least 0.4 point in 9 patients in the open group and in 10 patients in the endoscopic group. The mean (SD) CTS functional status score was 1.29 (0.5) in the open group and 1.30 (0.5) in the endoscopic group. At 5 years, 11 patients in the open group and 10 patients in the endoscopic group reported persistent pain in the scar or proximal palm. Three patients in each group had repeat surgery on the operated hand because of persistent or recurrent symptoms.

CONCLUSIONS

The improvements in symptoms of CTS and hand-related disability 5 years after open and 2-portal endoscopic carpal tunnel release were equivalent.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic I.