Table 1.
Endoscopic versus open carpal tunnel release for the treatment of carpal tunnel syndrome
| Ref | Study population | Symptoms at 3 months or less | Symptoms at more than 3 months | Return to work/activities of daily life |
| Systematic review; search date 2001/2002; 12 RCTs; 1388 people | Pain at 12 weeks, 4 RCTs, pooled OR 3.092, 95% CI 0.693 to 13.803 | NA | Time taken to return to work, 3 RCTs, pooled OR 1.516, 95% CI 0.276 to 8.341 | |
| Grip strength at 12 weeks, 3 RCTs, pooled effect size: 0.68, 95% CI 0.06 to 1.30 | ||||
| Pinch strength at 12 weeks, pooled effect size: 0.38, 95% CI 0.09 to 0.66 | ||||
| Systematic review; search date 2006, 19 RCTs, 1839 people | Symptom severity (as measured by the Levine scale) at 3 months or less, 3 RCTs, 451 people: mean difference –0.17, 95% CI –0.53 to +0.20. Statistical heterogeneity I2 = 88%, P = 0.00022. | Symptom severity (as measured by the Levine scale) after more than 3 months, 2 RCTs, 275 people: mean difference 0, 95% CI –0.17 to +0.17 | Time to return to work or activities of daily living, 3 RCTs, 294 people: mean difference –6.08 days, 95% CI –9.13 days to –3.03 days | |
| Function (as measured by the Levine scale) at 3 months or less, 3 RCTs, 451 people: mean difference –0.22, 95% CI –0.60 to –0.16. Statistical heterogeneity I2 = 90%, P = 0.00003. | Functional (as measured by the Levine scale) after more than 3 months, 2 RCTs, 275 people WMD +0.08, 95% CI –0.06 to +0.22 | |||
| RCT; 30 people with bilateral CTS; 60 hands | Wound pain at 2 weeks (1–10 VAS): 3.3 with ECTR v 2.5 with OCTR with modified incision; P = 0.004 | Wound or radial/ulnar pillar pain at 4, 6, and 12 months: data presented graphically; reported as NS | NA | |
| Wound pain at 4 weeks (1–10 VAS): 2.5 with ECTR v 1.5 with OCTR with modified incision; P = 0.008 | ||||
| Wound pain at 8 weeks: data not presented; reported as NS | ||||
| Radial/ulnar pillar pain at 4 weeks: data presented graphically; reported as NS | ||||
| Radial/ulnar pillar pain at 8 weeks: 16/30 (53%) with ECTR v 8/30 (27%) with OCTR with modified incision; P = 0.03 | ||||
| RCT; 123 people; 150 hands | Pain score (anterior carpal tenderness score from 11 = painless to 55 = severe pain) at 3 months: 22 with endoscopic surgery v 24 with open surgery; P = 0.18 | NA | Time to return to work (for 85/123 [69%] people in employment at baseline): 18 days with ECTR v 26 days with OCTR; mean difference: 8 days, 95% CI 2 days to 13 days | |
| Levine functional impairment score (8 = no impact to 40 = no activities possible) at 3 months: 109 with endoscopic surgery v 108 with open surgery; P = 0.98 | ||||
| Levine symptom score (11 = asymptomatic to 55 = severe symptoms) at 3 months: 120 with endoscopic surgery v 119 with open surgery; P = 0.70 | ||||
| RCT; 128 people; 128 hands | Postoperative pain score determined by severity of pain in the scar and proximal palm and extent to which tenderness of scar limited activity (each rated on 4-point scale, which was transformed into a combined score of 0 = none to 100 = severe pain or tenderness causing severe limitation of activity). Mean change in postoperative pain score (from baseline) at 3 months: 23.5 with endoscopic surgery v 36.2 with open surgery; P = 0.001 | Mean postoperative pain score at 12 months: 8.7 with endoscopic surgery v 13.9 with open surgery; P = 0.13 | Median time to return to work for people not on sick leave before surgery (53/63 [84%] assigned to endoscopic surgery and 59/65 [91%] assigned to open surgery): 28 days with endoscopic surgery v 28 days with open surgery; P = 0.9 Median time taken to return to work for people on sick leave before surgery (10/63 [16%] assigned to endoscopic surgery v 6/65 [9%] assigned to open surgery): 51 days with endoscopic surgery v 37 days with open surgery; significance not assessed | |
| Mean severity of symptoms (assessed using CTS questionnaire; lower score indicates decreased severity of symptoms; mean change in score from baseline reported). Symptom severity scale score at 3 months: 1.5 with endoscopic surgery v 1.5 with open surgery; P = 0.44 | Mean symptom severity scale score at 12 months: 1.4 with endoscopic surgery v 1.4 with open surgery; P = 0.96 | Mean SF-12 score at 12 months: 50.1 with endoscopic surgery v 49.8 with open surgery; P = 0.78 | ||
| Mean functional status scale (assessed using CTS questionnaire) score at 3 months: 1.3 with endoscopic surgery v 1.3 with open surgery; P = 0.82 | Mean functional status scale score at 12 months: 1.3 with endoscopic surgery v 1.2 with open surgery; P = 0.43 | |||
| Grip score (measured by hand dynamometer): 31.5 with endoscopic surgery v 29.9 with open surgery; P = 0.69 | ||||
| Pinch score (measure by pinch gauge): 6.7 with endoscopic surgery v 6.0 with open surgery; P = 0.15 | ||||
| RCT; 26 people; 36 hands | Improvement at 3 months: ECTR greater than OCTR with a modified incision; absolute numbers NR; reported as significant | NA | NA | |
| RCT; 45 people; 79% female; mean duration of symptoms 9 months | NA | NA | Mean: 24 days with ECTR v 42 days with OCTR; reported as significant | |
| RCT; 40 hands; 20 matched pairs | Pain completely relieved at 3 months: 20/20 (100%) hands with ECTR v 15/20 (75%) hands with OCTR; significance assessment NR | Pain completely relieved after 8 months: 20/20 (100%) hands with ECTR v 19/20 (95%) hands with OCTR; significance assessment NR | Mean: 20 days with ECTR v 30 days with OCTR; reported as significant | |
| Persisting paraesthesiae at 3 months: 1/20 (5%) hands with ECTR v 1/20 (5%) hands with OCTR; significance assessment NR | Persisting paraesthesiae after 8 months: 1/20 (5%) hands with ECTR v 1/20 (5%) hands with OCTR; significance assessment NR; reported as NS by review | |||
| RCT; 145 people; 169 hands | Improvement in paraesthesiae and numbness after 12 weeks: 99% with ECTR v 98% with OCTR; difference +1%, 95% CI −3% to +5% | NA | Median: 14 days with ECTR v 28 days with OCTR; reported as significant | |
| RCT; 71 people; 104 hands | Improvement in pain after 1, 2, and 4 weeks: ECTR greater than OCTR; absolute numbers NR; reported as significant | Improvement in pain after 6 months: absolute numbers NR; reported as NS | Mean: 14 days with ECTR v 39 days with OCTR; reported as significant | |
| Improvement in pain at 3 months: absolute numbers NR; reported as NS | Improvement in pain after 12 months: absolute numbers NR; reported as NS | |||
| RCT; 29 people; 32 hands | NA | NA | Mean: 17 days with ECTR v 19 days with OCTR; reported as NS | |
| RCT; 249 people; 251 hands; 54 with ECTR v 197 with OCTR | NR | NR | 17 days with ECTR v 17 days with OCTR; reported as NS | |
| RCT; 178 people | Mean symptom severity score at 3 months: 1.6 with ECTR v 1.5 with OCTR; reported as NS | NA | Proportion of people absent from work more than 4 weeks: 16% with ECTR v 13% with OCTR; difference: +3%, 95% CI −7% to +14% | |
| RCT; 122 people; 147 hands | Data not reported separately | Data not reported separately | Median: 25.0 days with ECTR v 46.5 days with OCTR; reported as significant | |
| RCT; 103 people; 60 with ECTR v 43 with OCTR | Persisting paraesthesiae at 3 months: 12% with ECTR v 7% with OCTR; significance assessment NR | Proportion of people with paraesthesiae after 6 months: 0% with ECTR v 0% with OCTR; significance assessment NR; reported as NS by review | Proportion of people returned to work at 1 month: 45% with ECTR v 72% with OCTR; P = 0.13 | |
| Persisting pain at 3 months: 38.5% with ECTR v 43.3% with OCTR; P = 0.71 | Proportion of people with persisting pain after 6 months: 25% with ECTR v 28% with OCTR; significance assessment NR | Proportion of people returned to work at 3 months: 72% with ECTR v 90% with OCTR; reported as NS | ||
| RCT; 25 people; 50 hands | Jebson scores at 3 months: 75 with ECTR v 65 with OCTR; reported as NS | Jebson scores after 12 months: 59 with ECTR v 48 with OCTR; significance assessment NR; reported as NS by review | NA | |
| RCT; 123 people | Pain (McGill score) after 12 weeks: 8 with ECTR v 12 with OCTR; reported as NS | Patient satisfaction scores after a mean 3.2 years: 85% with ECTR v 93% with OCTR; significance assessment NR; reported as NS by review | Absolute numbers NR; reported as NS | |
| Symptom severity (Levine score) after 12 weeks: 1.8 with ECTR v 2.0 with OCTR; reported as NS | ||||
| Functional status (SF-36 score) after 12 weeks: 47 with ECTR v 42 with OCTR; reported as NS | ||||
| RCT; 147 people; 192 hands | Patient satisfaction score at 3 months: 4.4 with ECTR v 4.0 with OCTR; reported as NS | Patient satisfaction score after 12 months: 4.6 with ECTR v 4.5 with OCTR; reported as NS | Median: 18 days with ECTR v 38 days with OCTR; reported as significant | |
| Symptom severity (Levine scale) at 3 months: 1.8 with ECTR v 2.5 with OCTR; reported as significant | Symptom severity (Levine scale) after 12 months: 1.8 with ECTR v 1.8 with OCTR; reported as NS | |||
| Functional status (Levine scale) at 3 months: 1.7 with ECTR v 2.4 with OCTR; reported as significant | Functional status (Levine scale) after 12 months: 1.7 with ECTR v 1.7 with OCTR; reported as NS | |||
| Data for this RCT extracted from systematic review | RCT; 80 people; 80 hands | Symptom severity score (variant of Levine) at 3 months: 11.0 with ECTR v 10.6 with OCTR; reported as NS | Mean: 34.5 days with ECTR v 36 days with OCTR; reported as NS | |
| Mean functional status score (variant of Levine) at 3 months: 10.2 with ECTR v 9.8 with OCTR; reported as NS | ||||
| Data for this RCT extracted from systematic review | RCT; 227 people. Three-arm trial comparing ECTR (110 people; 125 hands) v OCTR (54 people, 60 hands) v OCTR with modified incision (63 people; 65 hands) | NA | Mean overall severity score using a scale of 1–6 after more than 1 year: 2.1 with ECTR v 2.2 with OCTR; reported as NS | NA |
| Mean overall severity score using a scale of 1–6 after more than 1 year: 2.1 with ECTR v 2.2 with OCTR with modified incision; reported as NS | ||||
| RCT; 62 people, 72 hands | Improvement in 2-point discrimination from pre-operation to post-operation (time of postoperative assessment not clear): 0.6 mm with ECTR v 1.9 mm with OCTR; P greater than 0.05 | Proportion of people rating their satisfaction as excellent or good at about 2 years: 93.2% with ECTR v 91.5% with OCTR (absolute results NR); P greater than 0.05 | Time to return to work: 12 days with ECTR v 28 days with OCTR; P less than 0.01 |
ECTR, endoscopic carpal tunnel release surgery; NA, not assessed; NR, not reported; NS, reported as not significant; OCTR, open carpal tunnel release surgery; Ref, reference; SF, short form; VAS, visual analogue scale.