|
Back to 2017 Scientific Program ePosters
Single Surgeon Series of Outcomes of 1280 Consecutive Endoscopic Carpal Tunnel Releases Stratified by Disease Severity
Ellen S Satteson, MD1; David Person, MD2; Shruti C Tannan, MD1
1Wake Forest University School of Medicine, Winston-Salem, NC; 2Hand Center of San Antonio, San Antonio, TX
Introduction: Endoscopic carpal tunnel release (eCTR) has been reported as a safe and effective treatment of carpal tunnel syndrome (CTS). What has not been described is a stratification of postoperative results and relief of CTS based on objective pre-operative disease severity. This would allow more individualized preoperative counseling. For example, recovery after surgical release of severe CTS is usually described to patients as unpredictable at best, and yet indicated to prevent further decline and thenar atrophy.
Materials & Methods: Retrospective review was performed including all eCTR performed by a single hand-fellowship trained surgeon from 2011-2016. Demographic data, preoperative nerve conduction studies, electromyography, and response to carpal tunnel corticosteroid injection (when performed) were assessed, and outcomes including sensory symptom relief, complications, and recurrent CTS were analyzed. Subgroups were analyzed using Chi-square contingency tables based on pre-operative CTS severity—mild, moderate or severe as reported objectively on preoperative nerve conduction studies.
Results: A total of 778 patients underwent 1280 eCTR—502 bilateral and 276 unilateral. Only eight patients (10 hands, 0.8%) had recurrent symptoms at an average of 8 months post-operatively. Seven hands resolved without intervention, one resolved with corticosteroid injection, and one with open CTR. One failed to achieve symptom resolution despite open CTR. Rates of residual sensory deficit (0.4%), neuropraxia (1%), nerve injury (0.08%), and arterial injury (0%) were minimal (Tables 1 and 2). Workers' compensation status and lack of improvement with corticosteroid injection were not associated with recurrent symptoms. Seven patients (twelve hands) had previously undergone open CTR with another surgeon. Complete resolution of symptoms following revision eCTR was seen in 10 hands. The other two required additional surgery—one repeat eCTR and one open CTR with hypothenar fat pad—but went on to symptom resolution. Seventy percent of patients had pre-operative nerve conduction studies performed with results reported as mild, moderate, or severe disease. Comparison of resolution of symptoms, complication rates and need for revision surgery between these classifications revealed a significant difference only in neuropraxia and nerve injury rates, with higher rates occurring in the mild group (Table 3).
Conclusion: When performed by a high-volume, hand-fellowship trained surgeon, eCTR consistently treats CTS effectively in almost all patients with a very low complication rate, regardless of the pre-operative severity and even in those having previously failed open CTR. Based on these results, patients with severe CTS should expect relief of symptoms after endoscopic release of the carpal tunnel.
Back to 2017 Scientific Program ePosters
|
