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Global Translational Medicine Open carpal tunnel release surgical outcomes

diagnosis , and incomplete relaxation of the distal the wrist . The presence of ischemia and fibrotic nerve
[29]
[18]
portion of the transverse carpal ligament . Therefore, fiber bundles may contribute to persistent neurological
[29]
removing adequate TCL is a crucial first step in promoting symptoms, which are related to partial permanent damage
the success of CTS surgery, resulting in complete median to the median nerve. The persistence of preoperative
nerve decompression, symptom alleviation, and a reduced CTS symptoms frequently hinders the achievement of
recurrence rate. According to the results of a multivariable successful surgical outcomes . Unsatisfactory surgical
[30]
logistic regression model, other factors that contributed results are typically attributed to the incomplete sectioning
to a higher revision rate included age, male sex, bilateral of the TCL distal tract or, less commonly, the distal portion
carpal tunnel release, and ECTR. In addition, it was shown of the antebrachial fascia . It is imperative to ensure
[29]
that pre-operative splint therapy reduced the likelihood of complete incision of the TCL, regardless of the surgical
requiring revision surgery, while smoking and rheumatoid procedure chosen, to achieve median nerve relief in carpal
[31]
[29]
arthritis increased the cumulative risk . tunnel surgery, and reduce the rates of recurrence .
During the pre-operative stage, it was observed that 4.1. Limitations and recommendations
50.8% of the patients exhibited severe nerve compression.
Subsequently, the post-operative follow-up revealed While efforts were made to minimize confounding
a significant reduction in the dull aching discomfort effects related to differences in demographic factors such
in the hand and forearm, as well as paresthesia and as occupation and comorbid status, it is important to
numbness. Although there were no significant changes acknowledge that a majority of the research participants
in terms of clumsiness and thenar atrophy, notable were female in their 40s, which may have influenced the
symptomatic relief was evident after the surgery. study’s findings. Therefore, future research should aim to
A recent study conducted in Pakistan [32] also reported address this limitation by working with more homogenous
patient groups to mitigate the impact of confounders. Our
similar findings, where the majority of participants
(55.8%) presented with severe CTS during pre-operative study focused on assessing post-operative patient-reported
assessments. However, post-operative results indicated outcomes using the CTSAQ tool, specifically measuring
that 96%of them achieved symptomatic relief, with symptoms, severity, and function related to CTS. However,
it failed to identify any long-term disabilities among
only 3.9% reporting persistent symptoms. It is worth patients who experienced post-operative complications
noting that post-operative complications were found to or symptom recurrence. Our study employed a case series
be significantly linked to CTS severity, but not to the
patients’ BMI. While earlier research [14,15] established approach with the primary objective of investigating the
surgical outcomes of OCTR, and as such, we did not
a substantial correlation between higher BMI and the conduct subgroup analyses to compare at-risk groups.
occurrence of CTS, the underlying pathophysiological However, it would be valuable for future research to explore
mechanisms remain not fully understood [15] . the correlation between post-operative complications and
Furthermore, the high BMI levels were not found to
be associated with CTS severity [15] , which is a rather demographic variables such as age, gender, occupation,
and comorbid status to uncover significant findings.
surprising finding. In contrast, another study reported Therefore, future researchers should focus on addressing
[5]
that surgical outcomes for diabetic patients may vary the association between post-operative complications and
due to the direct influence of the disease itself on the demographic factors. Surgeons are encouraged to prioritize
clinical severity of CTS. The post-operative reduction a minimally invasive open release approach over the early
in the CTS Assessment Questionnaire (CTSAQ) score reduction of immobility and pain during the initial post-
(<1.04) among patients signifies a clinically significant operative days. This approach promotes better visualization
improvement in their health [33] . Therefore, it can be of neurovascular structures and increases the likelihood
inferred that a comprehensive diagnosis and severity of achieving a complete release, resulting in long-term
assessment plausibly play an important role in achieving symptomatic relief and a reduced risk of recurrence .
[34]
the optimal treatment modality for CTS patients.
Furthermore, future studies are recommended to compare
From a pathophysiological perspective, increased the clinical outcomes of new surgical interventions or
pressure within the carpal tunnel is a major contributing approaches in CTS treatment. Likewise, it is important to
factor to the etiology of CTS. The heightened pressure consider the role of conservative rehabilitative measures,
impairs blood supply to the median nerve, eventually such as physical therapy, during post-operative follow-up.
resulting in nerve damage and the clinical presentation of This can effectively manage CTS symptom recurrence,
symptoms. A significant proportion of CTS patients suffer facilitate faster recovery, and restore maximum wrist
from these symptoms due to repetitive motion injuries of function.

Volume 2 Issue 4 (2023) 7 https://doi.org/10.36922/gtm.1019