Aims: Carpal tunnel release is one of the most frequently used surgical procedures of hand surgery. Endoscopic carpal tunnel release is a new alternative technique of the standard open transverse carpal ligament release. In this study we present the effectiveness and complications of two-portal endoscopic carpal tunnel release. Methods: Between August 2000 and October 2001, we performed two portal (modiþed Chow technique) endoscopic carpal tunnel release to the 19 hands of 17 patients. Fifteen of these were female, two were male and mean age was 54.6 years (38–62 years). Mean follow up period was 8 months (4–21 months). Clinical evaluation was conþrmed with positive ENMG values. Patients were evaluated with the postoperative pain, numbness, scar sensation, returning to daily activities, and complications. Results: All the patients were satisþed with the relief of pain. They all returned to daily activities within two weeks after the operation. There was no hypersensitive scar formation. Numbness didnñt change at the six patients. In four patients, complication due to 3–4 common digital nerves injury occurred. Two of them explorated and interfascicular nerve repair was performed. Conclusions: Endoscopic carpal tunnel release has become popular because of the minimal perioperative morbidity, short hospitalization, early rehabilitation of the hand, less postoperative pain and less scarring. Our experience is the same agreement with those advantages. But digital nerve complications were more frequent then the open technique. Especially at the learning period the surgeon should have to be more careful for the complications

The aim of this prospective, randomised study is to compare outcomes within three groups of patients undergoing either open, one-portal or two-portal endoscopic carpal tunnel release. The study population consisted of 90 hands in 59 patients presenting with idiopathic carpal tunnel syndrome and symptom duration greater than 6 months, or those patients who had not gained satisfactory symptomatic relief from conservative treatments. Only patients with positive nerve conduction studies were included in the study. All patients were assessed using a standardised protocol which included a questionnaire on activities of daily living and symptoms experienced rated using a visual analogue scale. An examination followed which included; provocative tests; grip, pinch and abduction strengths; light touch; moving two-point discrimination; and vibration testing. Each patient was subsequently randomly allocated to one of the three surgical groups. All patients were assessed postoperatively, using a standa. We found no significant differences between the three surgical groups with regard to postoperative pain, level of satisfaction and objective return of grip and pinch strengths. The ability to perform activities of daily living postoperatively, however, was significantly reduced in the open technique group compared with patients treated with either endoscopic technique. There was also a significant difference in the time taken to return to work in the open group compared with both the endoscopic groups. No neurovascular complications occurred in our series. The only complications that occurred were in the open group and included; prolonged scar tenderness, severe post-operative bruising of the forearm, and infection

The June 2015 Wrist & Hand Roundup360 looks at: Collagenase and Dupuytren’s disease – a genuine alternative to surgery?; iPad PROMise?; Should we learn how to do endoscopic carpal tunnel release?; Two-week radiographs a relic of the past?; Bible? Aspirate or excise?; Patient expectations and trapeziometacarpal osteoarthritis; Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation

The August 2013 Wrist & Hand Roundup. 360 . looks at: random group therapy is no good at treating OA of the hand; salvaging failed CMCJ arthroplasty; scaphocapitate arthrodesis for instability in manual workers; Brunelli tenodesis and scapholunate instability; night splints for Dupytren’s revisited; the smallest IM nail?; early diagnosis of CRPS?; and endoscopic carpal tunnel release?

The August 2012 Wrist & Hand Roundup. 360. looks at: the Herbert ulnar head prosthesis; the five-year outcome for wrist arthroscopic surgery; four-corner arthrodesis with headless screws; balloon kyphoplasty for Kienböck's disease; Mason Type 2 radial head fractures; local infiltration and intravenous regional anaesthesia for endoscopic carpal tunnel release; perilunate injuries; and replanting the amputated fingertip

Introduction A randomised, double blind controlled study of the short term results of single portal endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) is presented. Methods Twenty patients undergoing bilateral carpal tunnel release were inducted into the study. Each patient had one side performed as an ECTR and the other as an OCTR. The side that ECTR was performed on was randomised. Assessment was performed at one, two and six weeks post-operatively by the patient and a blinded hand therapist. The patient was blinded at the one week review. Assessment looked at pain, function and satisfaction, as well as objective strength and motion. Results All patients prefered the side of the endoscopic release at one, two and six weeks. ECTR was associated with less pain, greater ease of use, improved strength and better motion. Conclusions There is a significantly improved short term outcome, on both subjective and objective measures, with endoscopic carpal tunnel release compared to open carpal tunnel release

This study compares the endoscopic carpal tunnel release with the conventional open technique with respect to short and long-term improvements of functional and clinical outcomes. We assessed 72 outpatients diagnosed with carpal tunnel syndrome. Thirty-seven patients underwent the endoscopic method according to Chow and 35 were assigned to the open method. Improvement in symptoms, severity and functionality were evaluated shortly preoperatively (at two days, one week and two weeks) and one year after using the Symptom Severity Scale, Symptom Severity Status and DASH questionnaire. Changes in clinical outcomes (grip strength, key pinch and two-point discrimination test) were evaluated one year postoperatively. Complications were also assessed. Both groups showed similar improvement in all but one outcome one year after the release; increase in grip strength was significantly higher for the endoscopic group. The endoscopic method was also associated with a significantly faster short-term improvement. Separate analysis of the questionnaire components referring to pain reveals that the delay of improvement in the open group is due to the persistence of pain for a longer period. Paresthesias and numbness decrease shortly after the operation with comparable rates for both groups

Aim: The purpose of this study was to evaluate the success and complication rate of endoscopic carpal tunnel release (ECTR) using the Chow technique in a large series of patients. Methods: Between September 1897 and February 2001, 2402 hands in 1698 patients underwent ECTRusing the Chow technique. The mean age of the patients was 51 years (14–96). The diagnosis of CTS was based on clinical symptoms and nerve conduction velocity test. Patients were evaluated by physical examination or interviewed by telephone for the current status of their hands. Patients were asked to report about any symptoms following surgery, including numbness, tingling, night pain, weakness and if present the severity of them. The return to work status was followed in 1156 patients. Results: The average follow-up was 6 years and 10 months (range 4 to 161 months). The average operating time was 8 minutes (ranged 5 to 27). A total of 2284 (95%) hands were completely asymptomatic or had very minor problems after ECTR. There were 26 complications, including perioperative (neurapraxias) and late (failed cases, recurrences, infections) complications. The overall complication rate was 1.1% but no serious complications were occurred in this series. Ninety percent of non-workerñs compensation patients and 60% of workerñs compensation patients return to work within 4 weeks. Conclusions: This study suggests that ECTR for carpal tunnel syndrome is a reliable procedure with a high success rate. Furthermore, the technique was found to be safe and iatrogenic complications can be avoided with meticulous surgical technique

The April 2015 Wrist & Hand Roundup360 looks at: Non-operative hand fracture management; From the sublime to the ridiculous?; A novel approach to carpal tunnel decompression; Osteoporosis and functional scores in the distal radius; Ulnar variance and force distribution; Tourniquets in carpal tunnel under the spotlight; Scaphoid fractures reclassified; Osteoporosis and distal radial fracture fixation; PROMISing results in the upper limb