Retractor-endoscopic nerve decompression in carpal and cubital tunnel syndromes: outcomes in a small series.
OBJECTIVE
To present midterm to long-term results obtained in carpal tunnel release, in situ decompression, and anterior transposition of the ulnar nerve using the retractor integrated endoscope.


METHODS
During the period 2000-2010, 145 patients underwent endoscopic carpal tunnel releases (n = 47), endoscopic in situ decompression of the ulnar nerve (n = 55), and endoscopic anterior transposition of the ulnar nerve (n = 52). Bilateral surgery was performed in 9 patients. Independent examinations at 24 months after surgery were used for objective results (Bishop score). Subjective results were procured using a questionnaire.


RESULTS
After endoscopic carpal tunnel release, 59.6% of patients showed excellent results, 21.2% showed good results, 12.8% showed fair results, and 6.4% showed poor results according to objective scoring. In 85% of patients, subjective improvement was noted after surgery; symptoms were the same as before surgery in 12.8% of patients and were worse in 2.1% of patients after surgery. After endoscopic in situ decompression, 56.4% of patients showed excellent results on objective scoring, 32.7% showed good results, 9.1% showed fair results, and 1.8% showed poor results. On subjective questioning, 72.7% of patients reported improvement, 20% reported no change in symptoms, and 7.3% reported worse symptoms. After endoscopic anterior transposition of the ulnar nerve, 48.1% of patients showed excellent results on objective scoring, 26.9% showed good results, 23.1% showed fair results, and 1.9% showed poor results. Subjectively, 65.4% of patients reported improvement, 26.9% reported no change in symptoms, and 7.7% reported worse symptoms. Patients with symptom duration of <9 months before surgery showed better results than patients with symptom duration of >9 months.


CONCLUSIONS
The retractor-endoscopic technique provides good long-term results after carpal tunnel release, in situ decompression, and anterior subcutaneous transposition of the ulnar nerve. Outcomes showed some correlation to the duration of preoperative symptoms.
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
K-Daniel
KD
Martin
Department of Neurological Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany.
Stephan
S
Dützmann
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
Stephan B
SB
Sobottka
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
Stefanie
S
Rambow
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
Helene A
HA
Mellerowicz
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
Thomas
T
Pinzer
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
Gabriele
G
Schackert
Department of Neurological Surgery, Justus Liebig University, Giessen, Germany. Electronic address: k_g_krishnan@hotmail.com.
Kartik G
KG
Krishnan
D000293:Adolescent; D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D015331:Cohort Studies; D020430:Cubital Tunnel Syndrome / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000601:surgery; D008875:Middle Aged; D009460:Neurologic Examination; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery; D055815:Young Adult
Carpal tunnel syndrome; Cubital tunnel syndrome; Endoscopic decompression; Transposition