gms | German Medical Science

Objectives/Interrogation: CTS affects an important part of active population, and leads to impairment in hand function, leading to surgical treatment when conservative measures fail.

There is still controversy regarding which technique would be more appropriate to treat this pathology.

In this study we evaluate and compare results of a single-approach endoscopic technique (Agee) and a mini-open procedure, to help the surgeon to decide wich technique is more efective.

Methods: In a one year period, a single surgeon treated 43 patients with carpal tunnel syndrome in an out-patient basis with two different methods:

Group A (Mini-open, n=16), were treated with mini-open approach over the retinaculum.

Group B, (endoscopic, n= 27) were treated endoscopicaly, with Agee single approach technique.

Post-operatively patients were examined at 2 days, 1 and 2 weeks and 1, 3 and 6 months if needed. All the patients were analyzed at the final follow-up using the Modified Mayo Hand score and Visual Analogue Scale.

Results and Conclusions: Average age, male-female ratio, and dominant - non-dominant ratio of both groups were similar.

Three initial endoscopic approaches were converted to mini-open due to incomplete visualization of retinaculum, and were excluded. Two patients of endoscopic group were revised with an open procedure, after maintaining the symptoms post-operatively, and in both cases we found an incomplete distal resection of the retinaculum.

Complication rate was 3/16 (22%) in group A, and 16/27 (53%) in group B. The main complaint of endoscopic group were transient paresthesias of the 2nd and 3rd fingers, lasting between 3 to 6 months post-operatively. No major complications were seen in this series. No significant difference were found in operative time between procedures

Endoscopic group have an early return to work (14 days vs 21 days in open group).

Cost evaluation show a lower cost in mini-open of 200 euros comparatively with endoscopic technique.

Average final Mayo score at 6 months were similar in both groups.

Endoscopic treatment of CTS provide shorter post-operative period but a longer period of residual paresthesias in about half of the patients.

Open treatment presents longer post-operative period, but better early functional outcome, without residual paresthesias or further surgical treatment.

In overall the mini-open procedure is more cost-effective than the endoscopic procedure, and should be preferred for the treatment of carpal tunnel syndrome.