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Endoscopic carpal tunnel release
J H Roth1, R S Richards, M D MacLeod
1Department of Surgery, University of Western Ontario, London.
Objective:
To assess the efficacy and safety of a new technique for carpal tunnel release.
Design:
A single-group prospective cohort study.
Setting:
A referral-based hand-surgery university practice.
Patients:
Ninety-five consecutive adults; 1 patient was excluded (35 men, 59 women). They underwent 108 surgical procedures. No patients were lost to follow-up.
Interventions:
Endoscopic carpal tunnel release. Outpatient surgery with neuroleptic anesthesia. Two-portal Chow technique of release.
Main Outcome Measures:
Symptom relief, return to work, medication use and complication rate.
Results:
The average preoperative duration of symptoms was 3.9 years. Nerve conduction studies were positive in 101 of the 108 hands. Only two patients required open release. Only eight patients complained of intraoperative pain. Six patients failed to obtain relief of symptoms; two of them required secondary open release owing to persistent symptoms. Of the 61 patients who were employed, 52 returned to their previous jobs without restriction. The mean time for return to work was 36.4 days for patients who were Workers' Compensation Board cases and 19.5 days for patients who were not (p < 0.01). Men returned to work in 17.7 days and women in 24.7 days (p < 0.05). Complications occurred in four patients (3.8%). No nerve injury, vascular injury or reflex sympathetic dystrophy was noted. Patients who had undergone previous contralateral open release noted less pain and earlier return to work after endoscopic carpal tunnel release.
Conclusions:
Endoscopic carpal tunnel release was effective in relieving symptoms and had a low complication rate. The technique was associated with early return to work and minimal palmar pain.