gms | German Medical Science

Objective: The goal of this study was to evaluate the interim neurological and neurophysiologic outcomes of retractor-endoscopic versus open release of carpal tunnel (CTS) and ulnar sulcus (CUS) after 3-months follow-up.

Method: Between May 2013 and June 2014, 36 patients were prospectively randomized to retractor-endoscopic or open decompression of the median or ulnar nerve. The patients were analyzed in four cohorts, open vs. endoscopic CTS and CUS in prospective double blinded randomized study.

Standard clinical examination and neurophysiological studies, following a patient questionnaire were conducted preoperatively and three months after surgery. All patients presented with typical clinical signs, symptoms and pathologic neurophysiologic examinations. The 3 months outcome included the time until return to full activity, the duration of postoperative pain and the classification of disease severity according to McGowan. Furthermore, the operation outcome was assessed using the Bishop Rating System. Statistical significance was validated using Mann-Whitney U and Chi-square tests.

Results: 36 patients (mean age, 55 years; range, 24-90 years) underwent retractor-endoscopic (n=20) or open (n=16) decompression of the median (n=22) or ulnar nerve (n=14). The retractor-endoscopic carpal tunnel group showed better outcomes with an experienced shorter time of postoperative pain (median 2 weeks), less actual discomfort and slightly better results in the Bishop rating system compared to the open procedure similarly to the open and retractor-endoscopic ulnar sulcus release (p>0.05). Excellent and good results in the Bishop rating system were attained in over 80% of the whole study population for all procedures. An improvement of the McGowan Score was seen from a median value of 2 to 1 in all four cohorts, respectively. The nerve conduction velocity was improved postoperatively in 61% of the patients with no statistical significance between the cohorts. After 3 months follow-up 64% and 50% patients had in retractor-endoscopic and open carpal tunnel release no complaints against 25% and 33% in retractor-endoscopic and open ulnar sulcus release, respectively. There were no technical or postoperative complications in the series.

Conclusions: Our results showed better results in the retractor-endoscopic procedure for carpal tunnel release. This new kind of endoscopic procedure is safe as well as effective and has the potential to better results compared with conventional methods.