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WCN: Open Carpal Tunnel Release Remains Treatment Of Choice By Richard Robinson Special to DG News LONDON, ENGLAND -- June 21, 2001 -- Open carpal tunnel release is as effective a treatment for carpal tunnel syndrome as are newer procedures, according to a study presented today at the 17th World Congress of Neurology here. According to the researchers, the simplicity and low cost of open carpal tunnel release (OCTR) make it the technique of choice in almost all patients with the condition. In recent years, standard OCTR has been supplemented or supplanted by several techniques designed to increase efficacy or reduce complications. "However, there is no consensus so far on which is the most effective approach," said Bernard Uitdehaag of the Department of Neurology at the VU Medical Center in Amsterdam. Dr. Uitdehaag and primary investigator Annette Gerritson undertook a systematic review of all published studies comparing carpal tunnel surgeries. Applying a high standard of inclusion, they identified 14 randomized, comparative trials for analysis. Differences in study methods precluded pooling of data for meta-analysis, but they did apply prospective criteria for comparison of both short- and long-term outcomes between studies. Half of the 14 studies compared OCTR to endoscopic surgery. None of these found any difference in short-term outcomes, and only one identified any difference in long-term outcomes, with a slight preference for endoscopic release in shortening the time to return to work. Balanced against this were the higher cost and a slight increase in numbness and paresthesia from endoscopy. One study that included analysis of cost effectiveness indicated that endoscopy is cost-effective if it returns the patient to work at least 21 days earlier than OCTR; however, only one of the 14 studies indicated this level of difference between the two procedures. None of the other procedures, including new open techniques or supplemental neurolysis or epineurotomy, showed any increased benefit compared to standard OCTR in either symptomatic relief, speed of return to work or activities of daily living. "OCTR still seems to be the preferred method of surgery for carpal tunnel syndrome," said Dr. Uitdehaag. "It is as effective as other methods, and technically it is less demanding." E-mail this page to a friend or colleague! To print, use this version