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A Comparative Analysis of Early Patient-Reported Outcomes in Endoscopic versus Open Carpal Tunnel Release
Emmanuel Emovon, BS
1; Joshua K Kim, BS
1; Steven L Zeng, BA
1; Daniel Joh, MD
1; D. Spencer Nicols, MD
1; Neill Li, MD
2; Warren C. Hammert, MD
1; Suhail K. Mithani, MD
31Duke University, Durham, NC; 2Duke University Medical Center, Durham, NC; 3Plastics and Reconstructive Surgery, Duke University Medical Center, Durham, NC
Introduction Carpal tunnel syndrome (CTS) is a common median nerve neuropathy, constituting 90% of all neuropathies.
1 Treatment options range from conservative measures to surgical intervention via open or endoscopic carpal tunnel release (CTR). Both approaches decompress the median nerve through transverse carpal ligament division but vary in incision size and instrumentation.
2 It is unknown how these differences affect early post-operative outcomes, with no consensus in literature.
3 Several randomized controlled trials have investigated post-operative outcomes between open and endoscopic CTR using validated patient measures.
4,5 However, to date, no prospective-matched cohort analysis has assessed the early postoperative outcomes using well-defined hand and upper extremity patient-reported outcome (PRO) measures such as the Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. This study seeks to fill this gap, focusing on early PROs.
Materials & Methods We conducted a single-institution prospective cohort study of patients undergoing endoscopic or open carpal tunnel release as index operations from August 2023 to January 2024. Patients planning to undergo CTR were enrolled before their surgery. Patient demographics and operative characteristics were recorded, with exclusion criteria including age less than 18, previous revision, EMG-documented peripheral neuropathy, and uncontrolled diabetes. Outcome variables measured included QuickDash Outcome and PROMIS scores. These were evaluated preoperatively and postoperatively at 1 week, 6 weeks, and 3 months.
Results Eighty patients were included. The endoscopic (n=30) and open (n=50) cohorts had comparable demographics. Preoperatively, there were no significant differences in QuickDash and PROMIS scores between cohorts. Postoperatively, patients undergoing endoscopic CTR exhibited significantly improved QuickDash and PROMIS Upper Extremity scores at 1 week compared to the open CTR cohort (p=0.025 and p=0.007, respectively). However, at six weeks and three months postoperatively, no significant differences in PROs were observed.
Conclusion In this prospective-matched cohort analysis, patients undergoing endoscopic CTR demonstrated significantly improved upper extremity function and decreased disability at one week postoperatively, as evidenced by a greater improvement in QuickDASH and PROMIS scores. While endoscopic CTR facilitated an earlier return to function and relief of symptoms compared to open CTR, these differences normalized by the sixth week after surgery.
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