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Global Translational Medicine Open carpal tunnel release surgical outcomes

1. Introduction method for reliably alleviating symptoms and performed
in current orthopedic practice involves the decompression
Carpal tunnel syndrome (CTS) is defined by the of the median nerve through an open release of the
American Academy of Orthopedic Surgeons (AAOS) as a transverse carpal ligament . In cases where surgery
[10]
“symptomatic compression neuropathy of the median nerve is indicated, it is essential to consider the potential for
at the level of the wrist” . This specific nerve entrapment significant complications. The clinical symptoms that may
[1]
neuropathy accounts for 90% of all neuropathies . CTS ensue following these complications can be more severe
[2]
stands as the most commonly diagnosed peripheral and distressing than the patients’ original complaints .
[1]
neuropathy, exhibiting a prevalence of 1 – 16% in the general
population , with a notable predominance in females . Irrespective of the chosen surgical technique, carpal
[3]
[4]
Clinically, CTS can be graded into mild, moderate, and tunnel surgery generally yields favorable results. While
severe forms based on the symptom’s history, presentation, ECTR has been demonstrated to offer a quicker recovery
and severity . Initial symptoms of CTS include discomfort time and reduced postoperative discomfort compared
[5]
[11]
or soreness, numbness, and paresthesia. These symptoms to OCTR, it may still result in a number of problems .
most frequently manifest in the thumb, index finger, The standard OCTR, which involves a longitudinal skin
middle finger, and radial half (thumb side) of the ring incision directly over the transverse carpal ligament, has
finger, although some variation may occur. In addition, consistently yielded favorable outcomes . However,
[12]
individuals with CTS may experience soreness in the this technique has been associated with difficult-to-treat
affected arm. As the condition worsens, hand weakness, complications, including discomfort in the scar, pain in
impaired fine motor coordination, clumsiness, and thenar the thenar and hypothenar (pillar) muscles, and weakness
[11]
[9]
muscle atrophy may become apparent. Various factors, in the pinch and grasp strength . A systematic review
including fluid retention, particularly during pregnancy, was conducted to compare OCTR and ECTR methods,
can contribute to the development of CTS. Patients often assessing post-surgical outcomes and complications.
[2]
report a worsening of their symptoms during the night, The study discovered that ECTR had a higher incidence
causing sleep disturbances . of superficial palmar arch injuries and transient nerve
[6]
damage between 1960 and 1990 .
[9]
CTS is a frequently encountered condition resulting
from the compression of the median nerve within the Lee and Strickland developed a limited-open technique
carpal tunnel of the wrist. However, if left untreated, it can employing specifically designed instruments known as the
result in long-term dysfunction and physical impairment . “Indian atome.” This approach features a smaller palmar
[6]
Notably, the progression of symptoms in CTS is not always incision, measuring just 1.5 cm in length, with the aim
linear, and in some cases, it spontaneously resolves over of minimizing the trauma caused by OCTR. The authors
time. In these circumstances, CTS may naturally resolve reported achieving results similar to those performed
or respond to minimal self-care measures. In cases where with ECTR while experiencing fewer complications .
[13]
symptoms persist, conservative treatments and non- This technique combines the simplicity of open release
surgical interventions, such as wrist splints or steroid with reduced surgical trauma, a smaller incision, and
injections, are frequently employed to manage mild-to- decreased postoperative morbidity. The procedure has
moderate symptoms. Surgical release (decompression) of been found to be straightforward to implement, and
the carpal tunnel becomes a consideration if non-surgical numerous patients have reported excellent outcomes with
[11]
remedies fail to alleviate the symptoms associated with fewer complications . Despite the advent of endoscopic
CTS [2,7] . release, the incidence of nerve injuries has not significantly
decreased, although there has been a gradual decline
The individualized treatment modality is customized
through a comprehensive assessment of several factors, in issues brought on by vascular injuries. The increased
including the severity of the symptoms of the limb, the rate of transient nerve injury and the accompanying
psychosocial status of the patient, and the surgeon’s capacity skin complications should be considered when deciding
[9]
to execute a well-outlined treatment plan with precision between these two widely used surgical methods .
and safety, all aimed at achieving a successful outcome . Older age, female sex, and a high body mass index (BMI)
[8]
In the management of CTS, a range of surgical procedures have all been identified as risk factors for CTS, according to
has been described, including endoscopic carpal tunnel a review article . High BMI was substantially associated
[14]
release (ECTR) or open carpal tunnel release (OCTR). with CTS, although not with the severity of the condition,
These techniques can be further categorized as traditional as confirmed by a cross-sectional analytical investigation
open, limited open, single-portal endoscopic, and two- that yielded comparable results . A crucial step in
[15]
portal endoscopic approaches . The preferred treatment defining the prognostic and therapeutic measures involves
[9]
Volume 2 Issue 4 (2023) 2 https://doi.org/10.36922/gtm.1019