A prospective randomized study comparing retractor-endoscopic vs. open release of carpal tunnel and cubital tunnel syndromes

• Published in: Clinical neurology and neurosurgery Vol. 222; p. 107437
• Main Authors: Schwarm, Frank P., Nagl, Jasmin, Graf, Katharina, Reinges, Marcus H.T., Uhl, Eberhard, Krishnan, Kartik G., Kolodziej, Malgorzata A.
• Format: Journal Article
• Language: English
• Published: Assen Elsevier B.V 01.11.2022; Elsevier Limited
• Subjects: Atrophy; Blood pressure; Carpal tunnel syndrome; Cubital tunnel syndrome; Decompression; Elbow; Endoscopy; Ligaments; Neurology; Outcome parameters; Pain; Patients; Questionnaires; Retractor-endoscopic and open decompression; Statistical analysis; Surgeons; Surgery; Carpal tunnel syndrome; Retractor-endoscopic and open decompression; Outcome parameters; Cubital tunnel syndrome
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2022.107437

To evaluate the neurological and neurophysiological outcomes of retractor-endoscopic versus open release in carpal tunnel syndrome (rCTS and oCTS, respectively) and cubital tunnel syndrome (rCbTS and oCbTS, respectively) at 3- and 12-month follow-up. Between 2013 and 2017, 80 patients were prospectively blindly randomized. McGowan scores were used for preoperative grading and outcomes were assessed using a modified Bishop rating system (BRS). Furthermore, incapacity to work, duration of postoperative pain, hypoesthesia, atrophy, subjective weakness, and a subjective assessment of the operative result were analyzed. The differences in the cohorts were evaluated with t-tests and ANOVAs as parametric tests and Kruskal-Wallis and Mann-Whitney U tests as nonparametric tests. The 80 patients underwent retractor-endoscopic or open decompression of the median or ulnar nerve. The rCTS group exhibited significant improvements in neurophysiological data (P = 0.032), shorter periods of postoperative pain (P = 0.03), and less discomfort (P = 0.005), as well as significantly better BRS results after 3 months compared with the oCTS group (P = 0.005). Between the oCbS and rCbTS groups, no significant differences were observed (P > 0.05). Regarding improvements in McGowan scores, no statistically significant differences were observed between the rCTS and oCTS groups after 3 months (P = 0.52) or 12 months (P = 0.86), nor were any observed between the rCbTS and oCbTS groups after 3 months (P = 0.88) or 12 months (P = 0.10). Significantly superior results were obtained at short-term follow-up for rCTS, whereas no superiority was found for rCbTS release. This study concluded that this endoscopic procedure is safe as well as and effective and has the potential to achieve better results in carpal tunnel syndrome compared with conventional methods. •Significantly superior results at short-term follow-up for retractor-endoscopic release in (rCTS).•Less postoperative discomfort and pain as well as the potential for earlier return to full activity and work in rCTS.•No superiority was for retractor-endoscopic cubital tunnel syndrome release (rCbTS).•Endoscopic procedure is safe as well as and effective and has the potential to achieve better results in carpal tunnel syndrome compared with conventional methods.