Effect of endoscopic and classic surgery for carpal tunnel syndrom

Česká verzia

Authors: M. Kanta ¹; E. Ehler ²; J. Kremláček ³; D. Laštovička ¹; J. Adamkov ¹; S. Řehák ¹; J. Habalová ¹; M. Bartoš ¹
Authors place of work: Neurochirurgická klinika, LF UK a FN Hradec Králové ¹; Neurologické oddělení, Pardubická krajská nemocnice, a. s ²; Ústav patologické fyziologie, LF UK, Hradec Králové ³
Published in the journal: Cesk Slov Neurol N 2008; 71/104(2): 173-179
Category: Original Paper

Summary

Objective:
The aim of the study was to compare the results of classic and endoscopic methods of carpal tunnel syndrome surgery.

Patient group and methodology:
29 endoscopically operated patients with mild or medium severe carpal tunnel syndrome, in which the carpal tunnel pressure was peroperatively measured using a Codman sensor (group 1), were statistically compared with an identical number of patients who had traditional surgery (group 2). The following EMG parameters were assessed preoperatively and 3 months after surgery: DML, A-CMAP, A-SNAP, SCV. Also evaluated was patient satisfaction, the presence of post-operative pain 3 months post-op, the time to complete hand function recovery, and the length of sickness disability.

Results:
Both groups presented with similar clinical and electrophysiological findings. A significant postoperative improvement in DML, ASNAP a SCV values was recorded. (p < 0.001) in both the groups. Improvement in ACMAP was only recorded for group 2 (p < 0.001). A significant difference between the two groups was recorded for this parameter in favour of group 2 (p < 0.05). Although conduction velocity increases occurred in both groups, the change in SCV in group 1 was statistically more significant (p < 0.05). Subjective patients’ ratings were significantly better in group 1 (satisfaction p < 0.01, post-operative pain p < 0.001, full hand function recovery p < 0.01, length of sickness disability p < 0.01).

Conclusions:
Based on EMG findings, results of endoscopic carpal tunnel syndrome surgery are fully comparable with those of traditional techniques in patients with mild to medium form of carpal tunnel syndrome. The only difference consists in an ACMAP increase (more for the traditional approach) and SCV (for the endoscopic approach). Endoscopic surgery had better results in terms of post-operative pain, full hand function recovery and subsequent return to work.

Key words:
carpal tunnel syndrome – uniportal endocsopic technique – intracarpal pressure measurement – traditional technique – electrophysiological tests – subjective evaluation

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