Carpal tunnel syndrome is the most common peripheral nerve compression disorder. Endoscopic release (ECTR) is a well accepted minimally invasive treatment method that hastens recovery while offering an acceptable complication rate. It can be performed through various techniques using a proximal, a distal or two portals. We have significant experience with the two portal (Chow) and with the one proximal portal (Agee) ECTR methods. This study compares our results and complications with these two methods.
We reviewed the medical records of all patients treated by the senior author at our center for isolated unilateral CTS using ECTR between January 1991 and August 2009. Bilateral ECTR cases and those presenting other associated surgical procedures were excluded. During this period we used both the two portal and the proximal portal techniques. The two portal technique (787 cases) was used mainly between 1991 and 1995 while the proximal portal technique (2359 cases) was used more frequently after 1995. All patients were treated as outpatients and under local or regional anesthesia. Postoperative management included a plaster slab short-arm post-operative dressing used for an average of six days, immediate finger motion and early functional use of the hand. Patients were seen at six days, one month and three months after surgery. Final functional results were assessed by measuring digital ROM, assessing for persistence of night paresthesia and for the presence of pain, tingling or numbness.
Of 3,146 hands that fit the inclusion criteria, we were able to follow 91% of them for at least 12 weeks. The mean time for return to work was 10 days. Immediate relief of night paresthesia was reported in 98% patients presenting with this symptom while 67% of patients with constant numbness had complete resolution at final follow-up. Complications include significant pillar pain (7 two portal and 13 proximal portal), transient median neuropathy (2 cases with two portal technique), digital neuropathy (3 two portal 4 proximal portal), laceration of the superficial arch (10 two portal and 4 proximal portal) reflex sympathetic dystrophy (2 two portal and 4 proximal portal).
Both methods provide early return to function and adequate relief of symptoms. The complication rate is acceptably low when the procedure is performed by one surgeon. The two portal technique presented increased incidence of median neuropathy and superficial arch laceration.
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