Dual-portal endoscopic release in carpal tunnel syndrome
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Published:
Nov 18, 2020
Keywords:
Carpal tunnel syndrome, Chow dual-portal technique, endoscopic release, neural compression, median nerve
Main Article Content
Abstract
Objective: To evaluate the outcomes of endoscopic release of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS) using the Chow dual-portal technique between January 2006 and December 2015. Materials and Methods: Study population consisted of 217 cases of idiopathic CTS, in 179 patients, 145 females (81%) (31 bilateral cases) and 34 males (19%) (7 bilateral cases), with an average age of 48.2 years (range, 32-68) and an average follow-up of 97.9 months. The symptom severity and functional evaluations were performed using the Boston Carpal Tunnel Questionnaire Symptoms Severity Scale (BCTQ-SSS)and the Functional Status Scale (BCTQ-FSS). Results: The average BCTQ-SSS was 3.20+0.26 in the preoperative period, which improved to 1.30+0.12 at the 6-month postoperative follow-up and remained at 1.25+0.11 in the long-term. The average BCTQ-FSS was 2.57+0.29 in the preoperative period, which improved to 1.28+0.12 at the 6-month postoperative follow-up and remained at 1.20+0.09 in the long-term. There were 7 cases (3.2%) of transient postoperative neurapraxia. No patient required to be converted to open technique. Conclusion: The endoscopic carpal tunnel release with Chow technique is an effective and safe surgical method for the treatment of idiopathic CTS.
Key words: Carpal tunnel syndrome; Chow dual-portal technique; endoscopic release; neural compression; median nerve.
Level of Evidence: III
Key words: Carpal tunnel syndrome; Chow dual-portal technique; endoscopic release; neural compression; median nerve.
Level of Evidence: III
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Ojeda, Álvaro C., Contreras, V. A., & Sanzana, E. S. (2020). Dual-portal endoscopic release in carpal tunnel syndrome. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(4), 349-356. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1062
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Clinical Research
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References
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6. Boya H, Özcan Ö, Özteki N. Long-term complications of open carpal tunnel release. Muscle Nerve 2008;38(5):
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8. Chow JC. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy
1989;5(1):19-24. https://doi.org/10.1016/0749-8063(89)90085-6
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https://doi.org/10.1016/S0363-5023(09)91047-4
11. Chow JC. The Chow technique of endoscopic release of the carpal ligament for carpal tunnel syndrome: four years of clinical results. Arthroscopy 1993;9(3):301-14. https://doi.org/10.1016/s0749-8063(05)80426-8
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13. Atroshi I, Hofer M, Larsson GU, Ornstein E, Johnsson R, Ranstam J. Open compared with 2-portal endoscopic
carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am 2009;34(2):266-72.
https://doi.org/10.1016/j.jhsa.2008.10.026
14. Okutsu I, Hamanaka I, Yoshida A. Retrospective analysis of five-years and longer clinical and electrophysiological results of the world’s first endoscopic management for carpal tunnel syndrome. Hand Surg 2013;18(3):317-23. https://doi.org/10.1142/S0218810413500330
15. Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2015;473(3):1120-32. https://doi.org/10.1007/s11999-014-3835-z
16. Argüelles S, Rodriguez M, Soutullo J, Santos G, Gelo M, Pereira E. Descompresión endoscópica del túnel carpiano. Resultados y complicaciones en 126 casos. Artroscopía 2018;25(4):131-5. https://www.revistaartroscopia.com.ar/ediciones-anteriores/images/artroscopia/volumen-25-nro-4/25_04_05_Arguelles/25_04_Arguelles.pdf
17. Chow JCY, Papachristos AA. Endoscopic carpal tunnel release: Chow technique. Tech Orthop 2006;21(1):19-29.
https://doi.org/10.1097/01.bto.0000221927.44752.6e
18. Sanz-Reig J, Lizaur-Utrilla A, Sanchez del Campo F, Maqueda-Abreu V. Estudio ecográfico del síndrome del túnel del carpo en la mujer. Rev Esp Cir Ortop Traumatol 2004;48(3):201-4. https://doi.org/10.1016/S1888-4415(04)76197-4
19. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire
for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993;75(11):1585-92. https://doi.org/10.2106/00004623-199311000-00002
20. Tulipan JE, Kim N, Ilyas AM, Matzon JL. Endoscopic carpal tunnel release with and without sedation. Plast
Reconstr Surg 2018;141(3):685-690. https://doi.org/10.1097/PRS.0000000000004113
21. Nath RK, Mackinnon SE, Weeks PM. Ulnar nerve transection as a complication of two-portal endoscopic carpal
tunnel release: a case report. J Hand Surg Am 1993;18(5):896-8. https://doi.org/10.1016/0363-5023(93)90063-9
22. Murphy RX, Jennings JF, Wukich DK. Major neurovascular complications of endoscopic carpal tunnel release.
J Hand Surg Am 1994;19(1):114-8. https://doi.org/10.1016/0363-5023(94)90233-X
23. De Smet L, Fabry G. Transection of the motor branch of ulnar nerve as a complication of two-portal endoscopic carpal tunnel release: a case report. J Hand Surg Am 1995;20(1):18-9. https://doi.org/10.1016/s0363-5023(05)80050-4
24. Ryu SJ, Kim IS. Pseudoaneurysm of ulnar artery after endoscopic carpal tunnel release. J Korean Neurosurg Soc 2010;48(4):380-2. https://doi.org/10.3340/jkns.2010.48.4.380
25. Chow JC, Hantes ME. Endoscopic carpal tunnel release: thirteen years’ experience with the Chow technique.
J Hand Surg Am 2002;27(6):1011-8. https://doi.org/10.1053/jhsu.2002.35884
26. Oertel J, Schroeder HWS, Gaab MR. Dual-portal endoscopic release of the transverse ligament in carpal tunnel
syndrome: result of 411 procedures with special reference to technique, efficacy, and complications. Neurosurgery 2006;59(2):333-40. https://doi.org/10.1227/01.NEU.0000223500.25131.99
27. Hankins CL, Brown MG, Lopez RA, Lee AK, Dang J, Harper RD. A 12-year experience using the Brown two-portal endoscopic procedure of transverse carpal release in 14.722 patients. Plast Reconstr Surg 2007;120(7):1911-21. https://doi.org/10.1097/01.prs.0000287287.85044.87
28. Uchiyama S, Nakamura K, Itsubo T, Murakami H, Hayashi M, Imaeda T, et al. Technical difficulties and their
prediction in 2-portal endoscopic carpal tunnel release for idiopathic carpal tunnel syndrome. Arthroscopy
2013;29(5):860-9. https://doi.org/10.1016/j.arthro.2013.01.027
29. Vasiliadis HS, Georgoulas P, Shrier I, Salanti G, Scholten RJPM. Endoscopic release for carpal tunnel syndrome.
Cochrane Database Sys Rev 2014;(1):CD008265. https://doi.org/10.1002/14651858.CD008265.pub2
30. Ip WJ, Sweed T, Fung KKB, Tipoe G, Pun TS. A new technique of single portal endoscopic carpal tunnel release.
Tech Hand Up Extrem Surg 2012;16(1):27-9. https://doi.org/10.1097/BTH.0b013e318230db42
31. Ecker J, Perera N, Ebert J. Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series. J Hand Surg Eur 2015;40(2):193-8. https://doi.org/10.1177/1753193414524688
32. Teh KK, Choo CH, Shanmugam R, Ngim JH, Ahmad TS. A novel supraretinacular endoscopic carpal tunnel release: Instrumentation and technique (cadaveric study). J Hand Surg Global Online 2019;1(4):222-5.
https://doi.org/10.1016/j.jhsg.2019.07.003
general population. JAMA 1999;282(2):153-8. https://doi.org/10.1001/jama.282.2.153
2. Paget J. Lectures on surgical pathology: Delivered at the Royal College of Surgeons of England. 2d American ed. Philadelphia: Lindsay & Blakiston; 1854:42-3.
3. Learmonth JR. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am 1933;13:905-13.
4. Rodner CM, Katrincic J. Open carpal tunnel release. Tech Orthop 2006;21(1):3-11.
https://doi.org/10.1097/01.bto.0000220086.17351.e2
5. Kluge W, Simpson R, Nicol A. Late complications after open carpal tunnel decompression. J Hand Surg Br 1996;
21(2):205-7. https://doi.org/10.1016/s0266-7681(96)80098-2
6. Boya H, Özcan Ö, Özteki N. Long-term complications of open carpal tunnel release. Muscle Nerve 2008;38(5):
1443-6. https://doi.org/10.1002/mus.21068
7. Okutsu I, Ninomiya S, Takatori Y, Ugawa Y. Endoscopic management of the carpal tunnel syndrome. Arthroscopy 1989;5(1):11-8. https://doi.org/10.1016/0749-8063(89)90084-4
8. Chow JC. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy
1989;5(1):19-24. https://doi.org/10.1016/0749-8063(89)90085-6
9. Agee JM, McCarroll HR, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: a
randomized prospective multicenter study. J Hand Surg Am 1992;17(6):987-95. https://doi.org/10.1016/s0363-5023(09)91044-9
10. Brown MG, Keyser B, Rothenberg ES. Endoscopic carpal tunnel release. J Hand Surg Am 1992;17(6):1009-11.
https://doi.org/10.1016/S0363-5023(09)91047-4
11. Chow JC. The Chow technique of endoscopic release of the carpal ligament for carpal tunnel syndrome: four years of clinical results. Arthroscopy 1993;9(3):301-14. https://doi.org/10.1016/s0749-8063(05)80426-8
12. Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ 2006;24:332 (7556):1473. https://doi.org/10.1136/bmj.38863.632789.1F
13. Atroshi I, Hofer M, Larsson GU, Ornstein E, Johnsson R, Ranstam J. Open compared with 2-portal endoscopic
carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am 2009;34(2):266-72.
https://doi.org/10.1016/j.jhsa.2008.10.026
14. Okutsu I, Hamanaka I, Yoshida A. Retrospective analysis of five-years and longer clinical and electrophysiological results of the world’s first endoscopic management for carpal tunnel syndrome. Hand Surg 2013;18(3):317-23. https://doi.org/10.1142/S0218810413500330
15. Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2015;473(3):1120-32. https://doi.org/10.1007/s11999-014-3835-z
16. Argüelles S, Rodriguez M, Soutullo J, Santos G, Gelo M, Pereira E. Descompresión endoscópica del túnel carpiano. Resultados y complicaciones en 126 casos. Artroscopía 2018;25(4):131-5. https://www.revistaartroscopia.com.ar/ediciones-anteriores/images/artroscopia/volumen-25-nro-4/25_04_05_Arguelles/25_04_Arguelles.pdf
17. Chow JCY, Papachristos AA. Endoscopic carpal tunnel release: Chow technique. Tech Orthop 2006;21(1):19-29.
https://doi.org/10.1097/01.bto.0000221927.44752.6e
18. Sanz-Reig J, Lizaur-Utrilla A, Sanchez del Campo F, Maqueda-Abreu V. Estudio ecográfico del síndrome del túnel del carpo en la mujer. Rev Esp Cir Ortop Traumatol 2004;48(3):201-4. https://doi.org/10.1016/S1888-4415(04)76197-4
19. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire
for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993;75(11):1585-92. https://doi.org/10.2106/00004623-199311000-00002
20. Tulipan JE, Kim N, Ilyas AM, Matzon JL. Endoscopic carpal tunnel release with and without sedation. Plast
Reconstr Surg 2018;141(3):685-690. https://doi.org/10.1097/PRS.0000000000004113
21. Nath RK, Mackinnon SE, Weeks PM. Ulnar nerve transection as a complication of two-portal endoscopic carpal
tunnel release: a case report. J Hand Surg Am 1993;18(5):896-8. https://doi.org/10.1016/0363-5023(93)90063-9
22. Murphy RX, Jennings JF, Wukich DK. Major neurovascular complications of endoscopic carpal tunnel release.
J Hand Surg Am 1994;19(1):114-8. https://doi.org/10.1016/0363-5023(94)90233-X
23. De Smet L, Fabry G. Transection of the motor branch of ulnar nerve as a complication of two-portal endoscopic carpal tunnel release: a case report. J Hand Surg Am 1995;20(1):18-9. https://doi.org/10.1016/s0363-5023(05)80050-4
24. Ryu SJ, Kim IS. Pseudoaneurysm of ulnar artery after endoscopic carpal tunnel release. J Korean Neurosurg Soc 2010;48(4):380-2. https://doi.org/10.3340/jkns.2010.48.4.380
25. Chow JC, Hantes ME. Endoscopic carpal tunnel release: thirteen years’ experience with the Chow technique.
J Hand Surg Am 2002;27(6):1011-8. https://doi.org/10.1053/jhsu.2002.35884
26. Oertel J, Schroeder HWS, Gaab MR. Dual-portal endoscopic release of the transverse ligament in carpal tunnel
syndrome: result of 411 procedures with special reference to technique, efficacy, and complications. Neurosurgery 2006;59(2):333-40. https://doi.org/10.1227/01.NEU.0000223500.25131.99
27. Hankins CL, Brown MG, Lopez RA, Lee AK, Dang J, Harper RD. A 12-year experience using the Brown two-portal endoscopic procedure of transverse carpal release in 14.722 patients. Plast Reconstr Surg 2007;120(7):1911-21. https://doi.org/10.1097/01.prs.0000287287.85044.87
28. Uchiyama S, Nakamura K, Itsubo T, Murakami H, Hayashi M, Imaeda T, et al. Technical difficulties and their
prediction in 2-portal endoscopic carpal tunnel release for idiopathic carpal tunnel syndrome. Arthroscopy
2013;29(5):860-9. https://doi.org/10.1016/j.arthro.2013.01.027
29. Vasiliadis HS, Georgoulas P, Shrier I, Salanti G, Scholten RJPM. Endoscopic release for carpal tunnel syndrome.
Cochrane Database Sys Rev 2014;(1):CD008265. https://doi.org/10.1002/14651858.CD008265.pub2
30. Ip WJ, Sweed T, Fung KKB, Tipoe G, Pun TS. A new technique of single portal endoscopic carpal tunnel release.
Tech Hand Up Extrem Surg 2012;16(1):27-9. https://doi.org/10.1097/BTH.0b013e318230db42
31. Ecker J, Perera N, Ebert J. Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series. J Hand Surg Eur 2015;40(2):193-8. https://doi.org/10.1177/1753193414524688
32. Teh KK, Choo CH, Shanmugam R, Ngim JH, Ahmad TS. A novel supraretinacular endoscopic carpal tunnel release: Instrumentation and technique (cadaveric study). J Hand Surg Global Online 2019;1(4):222-5.
https://doi.org/10.1016/j.jhsg.2019.07.003