Endoscopic versus open carpal tunnel release: a randomized trial.
OBJECTIVE
This study compared the outcomes in patients assigned to either endoscopic carpal tunnel release (ECTR) or traditional open carpal tunnel release (OCTR).


METHODS
An unbalanced randomized clinical trial (91 endoscopic, 32 open) was conducted. Short-term and long-term outcomes were evaluated by a blinded assessor. The primary outcome measures were symptom severity measured on a self-report scale and nerve/vascular complications. Secondary outcomes included the McGill pain questionnaire, grip strength, pinch strength, sensory threshold (NK PSSD device, NK Biotechnical Corp, Minneapolis, MN), and time to return to work.


RESULTS
Both groups improved on all outcomes. No differences were observed in primary outcomes between the groups at either baseline or follow-up at 1 week, 6 weeks, or 12 weeks after surgery. No significant complications occurred in either group. Grip strength and pain were significantly better at 1 and 6 weeks in the endoscopic group although differences dissipated by 12 weeks. No significant differences occurred in other secondary outcomes. Long-term satisfaction was lower in the endoscopic group, attributable to a 5% rate of re-operation. Lower rates of endoscopic release have occurred at our center once these results were available to surgeons and patients.


CONCLUSIONS
No substantive difference in benefit was shown for these 2 methods of carpal tunnel release.
Macdermid
Joy C
JC
Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, London, Ontario, Canada.
Richards
Robert S
RS
Roth
James H
JH
Ross
Doug C
DC
King
Graham J W
GJ
D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome