A 53-year-old woman had intermittent, bilateral hand numbness for more than 10 years;
it is persistent after cortisone injection and no longer responsive to splinting.
She is a self-employed jewelry designer whose work entails fine manipulation, with
frequent pinching and gripping activities. An electrodiagnostic study showed bilateral
carpal tunnel syndrome (CTS), right worse than left, without signs of denervation
of the abductor pollicis brevis. Examination demonstrates normal sensibility by Semmes-Weinstein
testing, positive Phalen's and Durkan's tests bilaterally, a “classic” hand diagram
depicting the distribution of her symptoms when present, normal abductor pollicis
brevis strength, and no thenar atrophy. The patient wants to return to occupational
pinching and gripping activities as quickly as possible, but her highest priority
is to avoid a career-ending complication, such as a major nerve injury.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome.Br J Surg. 2001; 88: 1285-1295
- Carpal tunnel release.J Bone Joint Surg. 1993; 75A: 1265-1275
- A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release.J Hand Surg. 1996; 21B: 202-204
- The value of one-portal endoscopic carpal tunnel release: a prospective randomized study.Knee Surg Sports Traumatol Arthrosc. 1995; 3: 113-116
- Endoscopic carpal tunnel decompression.J Hand Surg. 1994; 19B: 5-13
- Le canal carpien.Chirurgie. 1993; 119: 80-84
- Surgical treatment of carpal tunnel syndrome: endoscopic or classical (open)?.Ned Tijdschr Geneeskd. 1997; 141 ([in Dutch]): 878-882
- Endoskopische Operation oder konventionelle offene Operationstechnik bei Karpaltunnelsyndrom: eine prospektive, vergleichende Studie.Handchir Mikrochir Plast Chir. 1996; 28 ([Endoscopic operation or conventional open surgical technique in carpal tunnel syndrome: a prospective comparative study]): 128-132
- A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression.Plast Reconstr Surg. 2004; 114: 1137-1146
- Assessing the quality of reports of randomized clinical trials: is blinding necessary?.Control Clin Trials. 1996; 17: 1-12
- Endoscopic release of the carpal tunnel: a randomized prospective multicenter study.J Hand Surg. 1992; 17A: 987-995
- Agee endoscopic decompression of the median nerve: prospective study with comparison to open decompression.Handchir Mikrochir Plast Chir. 1996; 28 ([in German]): 151-155
- Postoperative strength after surgical release of the carpal tunnel: a randomized prospective study.Rev Bras Ortop. 1996; 31: 355
- Early results of conventional versus two-portal endoscopic carpal tunnel release.J Hand Surg. 1995; 20B: 658-662
- Early recovery after endoscopic vs. short-incision open carpal tunnel release.Ann Plast Surg. 2000; 44: 601-604
- Agee endoscopic operation of carpal tunnel syndrome in comparison with open surgical technique.Handchir Mikrochir Plast Chir. 1996; 28 ([in German]): 143-146
- CTS treatment guideline.(Link to PDF, “CTS Treatment Guideline.” Published 2008. Accessed January 23, 2009.)
- Evidence Report.(Link to PDF, “Evidence Report.” Published 2008. Accessed January 23, 2009.)
- Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial.BMJ. 2006; 332: 1473
- Endoscopic carpal tunnel release: a comparative study to the conventional open technique.Arq Neuropsiquiatr. 2005; 63 ([in Portuguese]): 637-642
- Intra-individual comparison between open and 2-portal endoscopic release in clinically matched bilateral carpal syndrome.J Plast Reconstr Aesthet Surg. 2006; 59: 730-736
- Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial.J Hand Surg. 2003; 28B: 444-449
- Endoscopic versus open surgical treatment of carpal tunnel syndrome.Neurosurg Clin N Am. 2001; 12: 255-266
- Surgical treatment options for carpal tunnel syndrome.Cochrane Database Syst Rev. 2007; 4
- Open versus endoscopic carpal tunnel release.Chir Praxis. 2003; 61 ([in German]): 279-283
- Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome.J Bone Joint Surg. 2002; 84B: 375-379
- Endoscopic versus open carpal tunnel release: a randomized trial.J Hand Surg. 2003; 28A: 475-480
- Single portal endoscopic carpal tunnel release compared with open release: a prospective randomized trial.J Bone Joint Surg. 2002; 84A: 1007-1115
- Course of clinical symptoms before and after surgical decompression in carpal tunnel surgery.Lymphologie in Forschung Und Praxis. 2000; 4: 69-73
- Carpal tunnel release.J Bone Joint Surg. 2003; 85B: 863-868
- A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.J Bone Joint Surg. 1993; 75A: 1585-1592
- The incidence of recurrence after endoscopic carpal tunnel release.Plast Reconstr Surg. 2000; 105: 1662-1665
- The results of revision carpal tunnel release following previous open versus endoscopic surgery.J Hand Surg. 1998; 23A: 865-869
- Endoscopic carpal tunnel release: thirteen years' experience with the Chow technique.J Hand Surg. 2002; 27A: 1011-1018
- Complications of endoscopic and open carpal tunnel release.Arthroscopy. 2006; 22: 919-924
- Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release?.J Hand Surg. 1999; 24B: 9-15
- Complications of endoscopic and open carpal tunnel release.J Hand Surg. 1999; 24A: 561-565
- Open versus endoscopic carpal tunnel release: a decision analysis.J Hand Surg. 1999; 24A: 1109-1117
- Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis.Plast Reconstr Surg. 1998; 102: 1089-1099
Article info
Publication history
Accepted:
January 11,
2009
Received:
January 11,
2009
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 Published by Elsevier Inc.
