gms | German Medical Science

Objective: The goal of this study was to evaluate and compare the neurological and neurophysiological outcomes of retractor-endoscopic versus open release of the carpal tunnel (rCTS and oCTS) and ulnar sulcus (rCUS and oCUS) after 3 and 12 months follow up.

Methods: Between May 2013 and November 2016, 64 patients were prospectively blinded randomized to retractor-endoscopic or open decompression of the median or ulnar nerve. Patients were analyzed in four cohorts, open vs. endoscopic CTS and CUS. Standard clinical, neurophysiological examination, and subjective assessment using a patient questionnaire were conducted preoperatively as well as 3 and 12 months after surgery. All patients presented with typical clinical signs, symptoms and pathologic neurophysiological examinations. Outcome measures included the time until return to full activity, duration of postoperative pain and the classification of disease severity according to McGowan. Surgical outcome was assessed using the Bishop Rating System (BRS). Statistical significance was calculated using the Mann-Whitney U and the Wilcoxon rank-sum test.

Results: 64 patients (median age, 52.5 years; range, 24-90 years) underwent retractor-endoscopic (n=37) or open (n=27) decompression of the median (n=37) or ulnar nerve (n=27). The rCTS group (n=21) showed better outcomes with a shorter time of postoperative pain (median: 2 weeks, range 0-15 weeks), less actual discomfort and better results in the BRS compared to oCTS (n=16) release after 3 and 12 months postoperatively. Excellent results in the BRS were obtained in 68% of the whole study population for all procedures after 12 months. The rCTS group showed excellent and good results in 100% of the cases. An improvement of the McGowan Score was seen from a median value of 2 to 1 in the rCTS, oCTS and rCUS cohort and from 1,5 to 1 in the oCUS cohort, respectively. Nerve conduction velocity was improved postoperatively in 78% of the patients with no statistical significance between the cohorts. After 12 months follow up patients' subjective assessment for symptom improvement was 95% and 81% in rCTS and oCTS release and 69% and 91% in rCUS and oCUS release, respectively. Statistical significant results were achieved in rCTS for less postoperative pain after 3 and 12 months (p=0.02), subjective assessment after 3 months (p=0.04), and in BRS after 3 and 12 months (p=0.02) in comparison to the oCTS cohort. The rCUS and oCUS cohorts showed no significant differences. There were postoperative complications in the series.

Conclusion: Our study shows significant better results in the retractor-endoscopic procedure for CTS release both in short and long term follow up. Less postoperative pain, improvement in the subjective assessment of symptoms, and higher BRS in rCTS after 3 months indicate a shorter recovery from surgery. There were no significant differences between rCUS and oCUS.