Update on surgical procedures for carpal tunnel syndrome: What is the current evidence and practice? What are the future research directions?

Valerio Pace, Fabrizio Marzano, Giacomo Placella, Valerio Pace, Fabrizio Marzano, Giacomo Placella

Abstract

Carpal tunnel syndrome (CTS) is a multifactorial compression neuropathy. It is reported to be very common and rising globally. CTS's treatment varies from conservative measures to surgical treatments. Surgery has shown to be an effective method for more severe cases. However few unclear aspects and room for further research and improvements still remains. We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS. The simple algorithm of leaving the choice of the surgical method to surgeons' preference and experience (together with consideration of patients' related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. We suggest that surgeons (unless in presence of precise indications towards endoscopic release) should tend to perform a minimally invasive open approach release, favoring the advantage of a better neurovascular structures visualization (and a consequent higher chance to perform a complete release with long term relief of symptoms) instead of favoring an early reduction (in the first postoperative days) of immobilization and pain. Research towards a universally accepted standardization should be aimed for by the researchers, who have failed to date to sufficiently limit bias and limitations.

Keywords: Carpal tunnel; Carpal tunnel release; Endoscopic release; Open release; Transverse ligament.

Conflict of interest statement

Conflict-of-interest statement: All the authors declare that they have no conflict of interest.

©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

References

    1. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282:153–158.
    1. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report, 2011. December 23, 2011; 60: 1697–1728. Available from: .
    1. Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, Burt S, Garg A, Kapellusch J, Merlino L, Thiese MS, Eisen EA, Evanoff B. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health. 2013;39:495–505.
    1. Karjalanen T, Raatikainen S, Jaatinen K, Lusa V. Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome. J Clin Med. 2022;11
    1. MacDonald E, Rea PM. A Systematic Review of Randomised Control Trials Evaluating the Efficacy and Safety of Open and Endoscopic Carpal Tunnel Release. Adv Exp Med Biol. 2022;1356:141–172.
    1. Meyers A, Annunziata MJ, Rampazzo A, Bassiri Gharb B. A Systematic Review of the Outcomes of Carpal Ligament Release in Severe Carpal Tunnel Syndrome. J Hand Surg Am. 2022
    1. De Smet L, Steenwerckx A, Van den Bogaert G, Cnudde P, Fabry G. Value of clinical provocative tests in carpal tunnel syndrome. Acta Orthop Belg. 1995;61:177–182.
    1. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padua L. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21:299–314.
    1. Wu PT, Chern TC, Wu TT, Shao CJ, Wu KC, Kuo LC, Jou IM. Safe Zones for Percutaneous Carpal Tunnel Release. Hand Clin. 2022;38:83–90.
    1. Cellocco P, Rossi C, El Boustany S, Di Tanna GL, Costanzo G. Minimally invasive carpal tunnel release. Orthop Clin North Am. 2009;40:441–448, vii.
    1. Kim PT, Lee HJ, Kim TG, Jeon IH. Current approaches for carpal tunnel syndrome. Clin Orthop Surg. 2014;6:253–257.
    1. Pripotnev S, Mackinnon SE. Revision of Carpal Tunnel Surgery. J Clin Med. 2022;11
    1. Okutsu I, Ninomiya S, Takatori Y, Ugawa Y. Endoscopic management of carpal tunnel syndrome. Arthroscopy. 1989;5:11–18.
    1. Hansen TB. Endoscopic decompression of carpal tunnel syndrome with the "Agee one-portal system". Ugeskr Laeger. 1997;159:5672–5674.
    1. Orhurhu V, Orman S, Peck J, Urits I, Orhurhu MS, Jones MR, Manchikanti L, Kaye AD, Odonkor C, Hirji S, Cornett EM, Imani F, Varrassi G, Viswanath O. Carpal Tunnel Release Surgery- A Systematic Review of Open and Endoscopic Approaches. Anesth Pain Med. 2020;10:e112291.
    1. Karamanos E, Jillian BQ, Person D. Endoscopic Carpal Tunnel Release: Indications, Technique, and Outcomes. Orthop Clin North Am. 2020;51:361–368.
    1. Tulipan JE, Ilyas AM. Carpal Tunnel Syndrome Surgery: What You Should Know. Plast Reconstr Surg Glob Open. 2020;8:e2692.
    1. Chow JC. Endoscopic carpal tunnel release. Two-portal technique. Hand Clin. 1994;10:637–646.
    1. Chow JC, Hantes ME. Endoscopic carpal tunnel release: thirteen years' experience with the Chow technique. J Hand Surg Am. 2002;27:1011–1018.
    1. Zuo D, Zhou Z, Wang H, Liao Y, Zheng L, Hua Y, Cai Z. Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2015;10:12.
    1. de Roo SF, Sprangers PN, Walbeehm ET, van der Heijden B. Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve. J Hand Surg Eur Vol. 2021;46:749–753.
    1. Vasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP, Brassington R, Scholten RJ, Salanti G. Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis. PLoS One. 2015;10:e0143683.
    1. Aslani HR, Alizadeh K, Eajazi A, Karimi A, Karimi MH, Zaferani Z, Hosseini Khameneh SM. Comparison of carpal tunnel release with three different techniques. Clin Neurol Neurosurg. 2012;114:965–968.
    1. Bai J, Kong L, Zhao H, Yu K, Zhang B, Zhang J, Tian D. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. Int J Surg. 2018;52:105–109.
    1. Palmer DH, Paulson JC, Lane-Larsen CL, Peulen VK, Olson JD. Endoscopic carpal tunnel release: a comparison of two techniques with open release. Arthroscopy. 1993;9:498–508.
    1. Li Y, Luo W, Wu G, Cui S, Zhang Z, Gu X. Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2020;21:272.
    1. Müller LP, Rudig L, Degreif J, Rommens PM. Endoscopic carpal tunnel release: results with special consideration to possible complications. Knee Surg Sports Traumatol Arthrosc. 2000;8:166–172.
    1. Kang HJ, Koh IH, Lee TJ, Choi YR. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res. 2013;471:1548–1554.
    1. Sanati KA, Mansouri M, Macdonald D, Ghafghazi S, Macdonald E, Yadegarfar G. Surgical techniques and return to work following carpal tunnel release: a systematic review and meta-analysis. J Occup Rehabil. 2011;21:474–481.
    1. Chou RC, Robinson DM, Homer S. Ultrasound-guided percutaneous carpal tunnel release: A systematic review. PM R. 2022
    1. David I. Sonography-Guided Carpal Tunnel Release. Hand Clin. 2022;38:75–82.
    1. Moungondo F, Feipel V. Percutaneous Sonographically Guided Release of Carpal Tunnel and Trigger Finger: Biomechanics, Clinical Results, Technical Developments. Hand Clin. 2022;38:91–100.
    1. Lanzetti RM, Astone A, Pace V, D'Abbondanza L, Braghiroli L, Lupariello D, Altissimi M, Vadalà A, Spoliti M, Topa D, Perugia D, Caraffa A. Neurolysis versus anterior transposition of the ulnar nerve in cubital tunnel syndrome: a 12 years single secondary specialist centre experience. Musculoskelet Surg. 2021;105:69–74.
    1. Pace V, Lanzetti RM, Venditto T, Park C, Kim WJ, Rinonapoli G, Caraffa A. Dorsally displaced distal radius fractures: introduction of Pacetti's line as radiological measurement to predict dorsal fracture displacement. Acta Biomed. 2021;92:e2021200.
    1. Valerio Pace, Pasquale Sessa, Matteo Guzzini, Marco Spoliti, Alessandro Carcangiu, Criseo N, Alessandro Giai Via, Luigi Meccariello, Auro Caraffa, Riccardo Maria Lanzetti. Clinical, functional and radiological outcomes of the use of fixed angle volar locking plates in corrective distal radius osteotomy for fracture malunion. Acta Biomed. 2021;92:e2021180.
    1. Ting J, Weiland AJ. Role of ancillary procedures in surgical management of carpal tunnel syndrome: epineurotomy, internal neurolysis, tenosynovectomy, and tendon transfers. Hand Clin. 2002;18:315–323.
    1. Chiang J, An VVG, Graham D, Lawson R, Sivakumar B. Flexor Synovectomy as an Adjunct to Carpal Tunnel Release in Primary Carpal Tunnel Syndrome: A Meta-Analysis. J Hand Surg Asian Pac Vol. 2021;26:497–501.
    1. Iwase Y, Ikai T, Hara A, Mori K, Kusonose K. Carpal tunnel release through a small incision using a special knife guide. Tech Hand Up Extrem Surg. 2002;6:193–195.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere