Endoscopic release for carpal tunnel syndrome

Area of Science:

• Orthopedics
• Neurosurgery
• Evidence-Based Medicine

Background:

• Carpal tunnel syndrome (CTS) is a common upper extremity compressive neuropathy.
• Surgical treatment involves releasing the median nerve by cutting the transverse carpal ligament.
• Surgical approaches include open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR).

Purpose of the Study:

• To assess the effectiveness and safety of endoscopic carpal tunnel release (ECTR) compared to other surgical interventions for CTS.
• To evaluate ECTR's impact on symptom relief, functional recovery, and complication rates.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and quasi-RCTs comparing ECTR with other surgical methods for CTS.
• Searches conducted up to November 2012, with preliminary updates to November 2013.
• Standard Cochrane Collaboration methodological procedures were used for data collection and analysis.

Main Results:

• No significant differences in symptom severity or functional status between ECTR and OCTR at short-term or long-term follow-up.
• ECTR showed improved grip strength and an average of eight days faster return to work compared to OCTR.
• ECTR was associated with a significantly lower rate of minor complications, while major complication rates were similar between groups.

Conclusions:

• ECTR and OCTR are comparable in relieving CTS symptoms and improving functional status, with potential benefits in grip strength for ECTR.
• ECTR demonstrates a faster return to work and fewer minor complications than OCTR.
• Conclusions are limited by low-quality evidence, high risk of bias, and statistical inconsistencies in the included studies.