AUTHOR=Zhang Fei , Jiang Hong , Lu Zhenfeng , Yang Haoyu , Zhang Qian , Mi Jingyi , Rui Yongjun , Zhao Gang 

TITLE=The significance of wrist immobilization for endoscopic carpal tunnel release

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1081440

DOI=10.3389/fneur.2023.1081440

ISSN=1664-2295

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: 24 patients with idiopathic carpal tunnel syndrome undergoing dual-portal ECTR from May 2020 to Feb 2022 were enrolled and randomly divided into 2 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), Semmes-Weinstein monofilament test (SWM test), the occurrence of pillar pain, digital and wrist range of motion (ROM), grip and pinch strength, visual analog score (VAS), Boston Carpal Tunnel Questionnaire (BCTQ) score , 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 2PD test, SWM test, digital and wrist ROM, BCTQ, and DASH score. 2 patients without splints reported transient scar discomfort. No one complained of neurapraxia, injury of 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. 
 
Conclusions: 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.