Abstract: Bilateral Endoscopic Carpal Tunnel Release, the New Standard of Care (Plastic Surgery The Meeting)

Sunday, September 25, 2016: 2:00 PM

Jordan Kaplan, BS , Cooper Medical School of Rowan University, Philadelphia, PA

Cameron Roth, MHS , Cooper Medical School of Rowan Universtiy, philadelphia, PA

Eden Koko, BSN , Cooper Medical School of Rowan University, philadelphia, PA

Atlee Melillo, BA , Cooper Medical School of Rowan University, Philadelphia, PA

David Fuller, MD , Cooper Bone and Joint Institute, Cooper University Hospital, Camden, NJ

Adam Perry, MD , Division of Plastic and Reconstructive Surgery, Northwell Health, Hofstra Northwell School of Medicine, Lake Success, NY

Background: Open carpal tunnel release has been the traditional treatment for carpal tunnel syndrome.[1],[2] For patients with bilateral carpal tunnel syndrome, this means two separate trips to the operating room for sequential open carpal tunnel release. Bilateral endoscopic carpal tunnel release done during a single trip to the operating room is less costly from an operative standpoint as well as from a recovery standpoint. This retrospective study compares outcomes for patients undergoing open carpal tunnel release versus bilateral endoscopic carpal tunnel release.[3],[4],[5]

Methods: The authors identified all patients who underwent open carpal tunnel release (62 cases), unilateral endoscopic carpal tunnel release (40 cases), and bilateral endoscopic carpal tunnel release (38 cases) at Cooper University Hospital from January 2012 to January 2014. Cases were identified using CPT billing codes and the data was assessed using an analysis of variance (ANOVA). All endoscopic carpal tunnel releases were done by the same surgeon (AP), and greater than 90% of open procedures were done by a different same surgeon (DF).

Results: The total combined complication rate was 24.7% with no significant difference (p>.05) between techniques. There were no major complications necessitating a return to the operating room. Variables that had a statistically significant difference between groups (p<.05) included mean tourniquet time, mean total procedure time, and return to work as determined from the number of follow-up appointments.

Conclusions: Bilateral endoscopic carpal tunnel release for patients with bilateral carpal tunnel syndrome is less costly than sequential open releases, and because both procedures have equivalent complication profiles, bilateral endoscopic carpal tunnel release is the preferred method for treating bilateral carpal tunnel syndrome.

[1] American Academy of Orthopaedic Surgeons Work Group Panel. Clinical guidelines on diagnosis of carpal tunnel syndrome. Available at: http://www.aaos.org/research/guidelines/CTS_Guideline.pdf. Accessed on March 12, 2015.

[2] Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6:69–76.

[3] Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8.

[4] Werner RA, Andary M. Carpal tunnel syndrome pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113(9):1373–81.

[5] Phalen GS. The carpal tunnel syndrome seventeen years experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg. 1966;48A:211–28.

29891 Bilateral Endoscopic Carpal Tunnel Release, the New Standard of Care