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


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).


CONCLUSIONS
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.
Department of Hand Surgery Huashan Hospital Fudan University Shanghai China.
Kejia
K
Hu
Department of Traditional Chinese Medicine Huashan Hospital Jing-an Branch (Jing-an District Central Hospital) Shanghai China.
Tiansong
T
Zhang
Department of Hand Surgery Huashan Hospital Fudan University Shanghai China.
Wendong
W
Xu
D002349:Carpal Tunnel Syndrome / Q000601:surgery* / Q000628:therapy*; D004724:Endoscopy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
Bilateral carpal tunnel syndrome; endoscopic carpal tunnel release; intraindividual comparison; meta‐analysis; open carpal tunnel release