Early versus delayed endoscopic surgery for carpal tunnel syndrome: prospective randomized study.

OBJECTIVE: To compare the effects of early versus delayed endoscopic surgery in patients with moderately severe carpal tunnel syndrome (CTS).

METHODS: The study included 100 patients with CTS. Investigations performed before surgery excluded secondary causes. Patients with moderately severe CTS (grade 3-4) were randomly assigned. Bland's neurophysiologic grading scale for CTS was used to assess the patients. Patients underwent an endoscopic carpal tunnel release using an indigenously designed instrument.

RESULTS: Following a course of conservative treatment, surgical treatment was offered in two groups: early surgery (n = 51; <1 week after diagnosis) and delayed surgery as per the usual waiting list (n = 49; >6 months after diagnosis). Improvement in both groups was significant (P < 0.001). When both groups were compared, improvement was better for the early surgery group (P < 0.001; confidence interval 6.35-9.12).

CONCLUSIONS: On the basis of this study, early endoscopic surgery is proposed in patients with moderately severe CTS.