Comparing the effectiveness of endoscopic carpal tunnel release between idiopathic and long-term hemodialysis patients

Background: Carpal tunnel syndrome (CTS) is recognized as an increasing morbidity in long-term hemodialysis patients. In general, the open method is the preferred technique of carpal tunnel release for most of the surgeons. Endoscopic carpal tunnel release (ECTR) is an alternative approach for idiopathic CTS, but its effectiveness for hemodialysis-related patients is still under dispute. Objectives: The purpose of current study was to compare the effectiveness of ECTR in treating CTS between long-term hemodialysis patients and idiopathic patients. Methods: From November 2008 to March 2011, we consecutively collected 26 patients with idiopathic CTS and 22 long-term hemodialysis patients with CTS by a single surgeon. All patients received ECTR for decompression of the median nerve. The effectiveness between the two groups of patients was analyzed by clinical observation, historical-objective scale, two kinds of self-administered questionnaires (QuickDASH and Boston carpal tunnel questionnaires), and objectively by electrophysiological evaluation preoperatively and 3 months postoperatively. Results: With regard to the historical-objective scale, the hemodialysis group had significantly more severe grades than the idiopathic group in preoperative and postoperative evaluations. Both groups showed significant improvement after the ECTR. According to the self-administered questionnaire results, there was no significant difference of the effectiveness of ECTR between the groups. Hemodialysis-related CTS was found to have more advanced electrophysiologic findings, and no significant improvement of electrophysiologic grading can be recognized in this group of patients. Conclusion: ECTR was effective in both groups of patients, but the severity of their pre-operative status, especially with advanced involvement, may compromise the objective results. Although the results from the self-administered questionnaires and the electrophysiological findings were inconsistent in these hemodialysis-related patients, it is possible to have satisfactory results in symptoms and questionnaires but with the less satisfactory electrophysiological outcome.