The significance of wrist immobilization for endoscopic carpal tunnel release

Fei Zhang; Hong Jiang; Zhenfeng Lu; Haoyu Yang; Qian Zhang; Jingyi Mi; Yongjun Rui; Gang Zhao

doi:10.3389/fneur.2023.1081440

The significance of wrist immobilization for endoscopic carpal tunnel release

Front Neurol. 2023 Apr 25:14:1081440. doi: 10.3389/fneur.2023.1081440. eCollection 2023.

Authors

Fei Zhang¹, Hong Jiang², Zhenfeng Lu¹, Haoyu Yang¹, Qian Zhang¹, Jingyi Mi³, Yongjun Rui⁴, Gang Zhao¹

Affiliations

¹ Department of Hand Surgery, WuXi 9th People's Hospital Affliated to SooChow University, Wuxi, China.
² Suzhou Medical College of Soochow University, Soochow University, Suzhou, China.
³ Department of Sport Medicine, WuXi 9th People's Hospital Affliated to Soochow University, Wuxi, China.
⁴ Department of Orthopeadics Surgery, WuXi 9th People's Hospital Affliated to Soochow University, Wuxi, China.

Abstract

Background: Over the years, endoscopic carpal tunnel release (ECTR) has gained significant interest as an alternative to surgery. However, no consensus has been reached on the necessity of postoperative wrist immobilization. This study aims to compare the outcomes of wrist immobilization for a period of 2 weeks to immediate wrist mobilization after ECTR.

Methods: A total of 24 patients with idiopathic carpal tunnel syndrome undergoing dual-portal ECTR from May 2020 to Feb 2022 were enrolled and randomly divided into two groups postoperatively. In one group, patients wore a wrist splint for 2 weeks. In another group, wrist mobilization was allowed immediately after surgery. The two-point discrimination test (2PD test); the Semmes-Weinstein monofilament test (SWM test); the occurrence of pillar pain, digital and wrist range of motion (ROM); grip and pinch strength; the visual analog score (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ) score; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and complications were evaluated at 2 weeks and 1, 2, 3, and 6 months after the surgery.

Results: All 24 subjects finished this study with no dropouts. During the early follow-up, patients with wrist immobilization demonstrated lower VAS scores, lower occurrence of pillar pain, and higher grip and pinch strength compared with the immediate mobilization group. No significant difference was obtained between these two groups in terms of the 2PD test, the SWM test, digital and wrist ROM, BCTQ, and the DASH score. In total, two patients without splints reported transient scar discomfort. No one complained of neurapraxia, injury of the flexor tendon, median nerve, and major artery. At the final follow-up, no significant difference was found in any parameters between both groups. The local scar discomfort mentioned above disappeared and left no serious sequela.

Conclusion: Wrist immobilization during the early postoperative period demonstrated significant pain alleviation along with stronger grip and pinch strength. However, wrist immobilization yielded no obvious superiority regarding clinical outcomes at the final follow-up.

Keywords: carpal tunnel syndrome; endoscopic carpal tunnel release; immobilization; median nerve; transverse carpal ligament.

Grants and funding

This study was supported by the Subsidy Program for Young and Middle-aged Top Talents of Wuxi Municipal Health Commission, the Postdoctoral Research Funding Program of Jiangsu Province (2020Z359), and the Binhu Medical Expert Team of “Light of Binhu Program”.