Early functional recovery improved with ultra-minimally invasive carpal tunnel release

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
92 patients with carpal tunnel syndrome were randomized to undergo either 1mm ultra-minimally invasive ultrasound-guided carpal tunnel release or 2cm blind mini-open carpal tunnel release. The purpose of this study was to compare the two techniques with regards to postoperative Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, as well as grip strength, time to discontinuation of oral analgesics, full wrist flexion-extension, paresthesia relief, and return to pre-injury function. Outcomes were measured Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
CONTENT IS LOCKED
Why was this study needed now?
Carpal tunnel release is often recommended for patients with severe cases of carpal tunnel syndrome who are unresponsive to conservative therapy. There are a number of surgical techniques that can be used to perform the release and each has their advantages and disadvantages. Minimally invasive or endoscopic procedures can be limited by incomplete release and traditional open procedures can potentially lead to greater post-operative pain and longer functional recovery. Ultrasound-guided mini, percutaneous, and ultra-minimally invasive carpal tunnel release techniques require smaller incisions and have recently gained popularity, as they avoid the limitations of the other surgical techniques. A previously conducted pilot study demonstrated positive clinical outcomes yielding significantly greater functional recovery within a shorter time frame using the ultra-minimally invasive release technique compared to a mini-open release. However, the study may have been inadequately powered, thus warranting the present study to verify the previous results.
What was the principal research question?
In the treatment of carpal tunnel syndrome, does an ultrasound-guided ultra-minimally invasive carpal tunnel release procedure provide significantly improved clinical outcomes compared to a blind mini-open carpal tunnel release procedure when assessed over a 12-month period postoperatively?
Population: 92 patients, 18 years of age or older, with primary carpal tunnel syndrome confirmed by positive electrodiagnostic test results.
Intervention: Ultra-minimally invasive release group: an ultrasound-guided proximal distal forearm incision of 1mm was performed (M-Turbo portable device, 6–15-MHz linear array; SonoSite, Inc, Madrid, Spain) to release the deepest fibrous layer of the carpel tunnel. Afterwards, the wound was covered with nonadherent dressing (Opside, 66000708; Smith & Nephew, Memphis, TN) (n=46, 41 analyzed; Mean age: 58.21 [Range: 29-83]; 27F/19M)
Comparison: Blind mini-open release group: a 2cm curved skin incision was performed using mini retractors and surgical scissors, starting parallel to the thenar crease and ending distal to the transverse wrist crease, to release the distal portion of the deepest fibrous layer. Afterward, the wound was closed using Ethilon 4-0 sutures (Ethicon, Somerville, NJ) (n=46, 41 analyzed; Mean age: 59.32 [Range: 30-84]; 29F/17M)
Outcomes: the primary outcome was the postoperative QuickDASH questionnaire score. Additional outcomes included grip strength rate measured using a hand dynamometer, 2-point discrimination, time taken to stop the use of oral analgesics (days), recovery of full wrist ROM, and return to pre-injury activity level. Complications were also documented.
Methods: RCT; single-center
Time: Outcomes were assessed at 1-, 3-, and 6-weeks, and 3-, 6-, and 12-months postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.