Safety and Effectiveness of Single Portal Supra-Retinacular Endoscopic Carpal Tunnel Release in Treatment of Idiopathic Carpal Tunnel Syndrome

Abstract

Background: The most common entrapment neuropathy of the upper limb is Carpal tunnel syndrome (CTS). Endoscopic carpal tunnel  release (ECTR) is superior to open CTR. Fewer techniques exist using instruments to guide endoscope from outside carpal tunnel and  published reports regarding that are quite rare. This study is to evaluate safety and effectiveness of single portal supra-retinacular ECTR  in treatment of idiopathic CTS.

Methods: This study included consecutive patients with idiopathic CTS underwent single portal supra- retinacular ECTR from December 2019 to June 2020 with postoperative follow-up period of 6 months. The Boston Carpal Tunnel Syndrome  Questionnaire (BCTSQ) results at 1-, 3-, and 6-months postoperative compared to pre-operative scores as main clinical  evaluation. In addition to scar tenderness scale, recurrence of symptoms and post-operative complications.

Results: 45 patients aged  from 29 to 63 years were included (a total of 51 procedures). There was a significant improvement in Functional Status Score (FSS) and  Symptom Severity Score (SSS) post-operative compared to pre-operative scores (P=0.0001). And also, a significant progressive reduction  in mean FSS/SSS recorded 1, 3 and 6-months postoperative than pre-operative. Pillar pain recorded in 7 hands and disappeared in 3  patients during follow up. No wound infection. Recurrent symptoms were not detected at end of follow-up.

Conclusion: This technique is  safe and effective alternative to Infra-Retinacular ECTR in treatment of idiopathic CTS. Also, it is simple, less expensive technique enabling  complete division of transverse carpal ligament and avoiding higher risk for transient median nerve dysfunction.