Comparison of Two Techniques for the Treatment of Carpal Tunnel Syndrome

NCT ID: NCT05468814

Last Updated: 2024-09-19

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-18

Study Completion Date

2023-05-28

Brief Summary

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The main objective of this study is to compare the complete section of the transverse carpal ligament with another median nerve release technique and to determine if the incidence of post-surgical pillar pain is lower for either of the two surgical techniques. As secondary objectives, we also seek to determine if the postsurgical grip and pincer strength and the Boston Carpal Tunnel Questionnaire (BCTQ) score are better for either of the two surgical techniques.

Detailed Description

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It will be a randomized clinical trial with a sample size of about 80 patients. It will have two study groups: the experimental group (in which 40 patients will be included) where a Z-plasty technique will be applied; and the control group (another 40 patients) who will undergo the conventional technique of complete section of the transverse carpal ligament. The main variable will be the presence or absence of post-surgical pillar pain and, as secondary variables, the recovery of grip and pincer strength and the improvement in the BCTQ score will be studied.

The study population will be patients with carpal tunnel syndrome diagnosed clinically (pain and paresthesias in the first three fingers and radial edge of the fourth finger, nocturnal paresthesias, thenar muscle atrophy, loss of thumb opposition), examination (Durkan's signs , Phalen and Tinnel positive) and with a positive electromyogram test classified as "moderate" or "severe". As inclusion criteria, patients \>18 years of age with moderate-severe carpal tunnel syndrome whose symptoms hinder the daily activities of the patient and who have failed conservative treatment will be considered. Those who have already undergone a previous surgical intervention for carpal tunnel syndrome in the same hand, who have traumatic or congenital sequelae in the hand or who do not have the capacity to understand the process or the tests to be performed will be excluded.

The total expected duration of each patient in the study will be 6 months and the following visits and procedures will be carried out: clinical study and quality questionnaires prior to surgery and post-surgical follow-up at 3-4 weeks and at 6 months in consultation, with repetition of clinical examination and quality questionnaires.

The incidence of pillar pain (defined as pain/sensation of allodynia in the area of the thenar and/or hypothenar eminence, hyperalgesia in the scar, pain when supporting the heel of the hand, dysesthesia at rest) will be analyzed applying the principle of intention to treat, using the Mann Whitney test to compare the score in the tests used.

Conditions

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Carpal Tunnel Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomly assigned to one of two treatment groups in a 1:1 ratio, using a computer-generated random assignment list
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers
This is a double-blind study, in which both the patient and the evaluating staff are unaware of the surgical technique used (both surgeons will perform both techniques). A traumatologist will analyze (before and after surgery) the clinic, strength and satisfaction of the patients.

Study Groups

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Z-plasty

It is a surgical technique in which a Z-shaped section of the transverse carpal ligament is performed, to later join both ends with a resorbable stitch.

Group Type EXPERIMENTAL

Z-plasty

Intervention Type PROCEDURE

It is a surgical technique in which a Z-shaped section of the transverse carpal ligament is performed, to later join both ends with a resorbable stitch.

Conventional

It is a surgical technique in which a complete section of the transverse carpal ligament is performed, without subsequent closure.

Group Type ACTIVE_COMPARATOR

Conventional

Intervention Type PROCEDURE

It is a surgical technique in which a complete section of the transverse carpal ligament is performed, without subsequent closure.

Interventions

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Z-plasty

It is a surgical technique in which a Z-shaped section of the transverse carpal ligament is performed, to later join both ends with a resorbable stitch.

Intervention Type PROCEDURE

Conventional

It is a surgical technique in which a complete section of the transverse carpal ligament is performed, without subsequent closure.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years
* Moderate-severe carpal tunnel syndrome
* Symptoms that hinder the patient's daily activities
* Correct conservative treatment without success

Exclusion Criteria

* Previous surgical intervention for carpal tunnel syndrome
* Traumatic or congenital sequelae of the hand
* Incompetence to understand the process and the tests to be carried out
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitario Reina Sofia de Cordoba

OTHER_GOV

Sponsor Role lead

Responsible Party

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Irene Calzado Álvarez de Lara

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Hospital Universitario Reina Sofia

Córdoba, , Spain

Site Status

Countries

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Spain

References

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Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal Tunnel Syndrome: A Review of Literature. Cureus. 2020 Mar 19;12(3):e7333. doi: 10.7759/cureus.7333.

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Ludlow KS, Merla JL, Cox JA, Hurst LN. Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther. 1997 Oct-Dec;10(4):277-82. doi: 10.1016/s0894-1130(97)80042-7.

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Murthy PG, Goljan P, Mendez G, Jacoby SM, Shin EK, Osterman AL. Mini-open versus extended open release for severe carpal tunnel syndrome. Hand (N Y). 2015 Mar;10(1):34-9. doi: 10.1007/s11552-014-9650-x.

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Bai J, Kong L, Zhao H, Yu K, Zhang B, Zhang J, Tian D. Carpal tunnel release with a new mini-incision approach versus a conventional approach, a retrospective cohort study. Int J Surg. 2018 Apr;52:105-109. doi: 10.1016/j.ijsu.2018.02.033. Epub 2018 Feb 20.

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Chen L, Duan X, Huang X, Lv J, Peng K, Xiang Z. Effectiveness and safety of endoscopic versus open carpal tunnel decompression. Arch Orthop Trauma Surg. 2014 Apr;134(4):585-93. doi: 10.1007/s00402-013-1898-z. Epub 2014 Jan 12.

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Michelotti BM, Vakharia KT, Romanowsky D, Hauck RM. A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient. Hand (N Y). 2020 May;15(3):322-326. doi: 10.1177/1558944718812129. Epub 2018 Nov 21.

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Shin EK. Endoscopic Versus Open Carpal Tunnel Release. Curr Rev Musculoskelet Med. 2019 Dec;12(4):509-514. doi: 10.1007/s12178-019-09584-0.

Reference Type BACKGROUND
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Kang HJ, Koh IH, Lee TJ, Choi YR. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res. 2013 May;471(5):1548-54. doi: 10.1007/s11999-012-2666-z. Epub 2012 Oct 26.

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Hu K, Zhang T, Xu W. Intraindividual comparison between open and endoscopic release in bilateral carpal tunnel syndrome: a meta-analysis of randomized controlled trials. Brain Behav. 2016 Feb 16;6(3):e00439. doi: 10.1002/brb3.439. eCollection 2016 Mar.

Reference Type BACKGROUND
PMID: 27099801 (View on PubMed)

Zuo D, Zhou Z, Wang H, Liao Y, Zheng L, Hua Y, Cai Z. Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2015 Jan 28;10:12. doi: 10.1186/s13018-014-0148-6.

Reference Type BACKGROUND
PMID: 25627324 (View on PubMed)

Orhurhu V, Orman S, Peck J, Urits I, Orhurhu MS, Jones MR, Manchikanti L, Kaye AD, Odonkor C, Hirji S, Cornett EM, Imani F, Varrassi G, Viswanath O. Carpal Tunnel Release Surgery- A Systematic Review of Open and Endoscopic Approaches. Anesth Pain Med. 2020 Dec 26;10(6):e112291. doi: 10.5812/aapm.112291. eCollection 2020 Dec.

Reference Type BACKGROUND
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Teng X, Xu J, Yuan H, He X, Chen H. Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center. Med Sci Monit. 2019 Jun 3;25:4122-4129. doi: 10.12659/MSM.912912.

Reference Type BACKGROUND
PMID: 31155608 (View on PubMed)

Xu L, Huang F, Hou C. Treatment for carpal tunnel syndrome by coronal Z-type lengthening of the transverse carpal ligament. J Pak Med Assoc. 2011 Nov;61(11):1068-71.

Reference Type BACKGROUND
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Castro-Menendez M, Pagazaurtundua-Gomez S, Pena-Paz S, Huici-Izco R, Rodriguez-Casas N, Montero-Vieites A. Z-Elongation of the transverse carpal ligament vs. complete resection for the treatment of carpal tunnel syndrome. Rev Esp Cir Ortop Traumatol. 2016 Nov-Dec;60(6):355-365. doi: 10.1016/j.recot.2016.06.007. Epub 2016 Aug 25. English, Spanish.

Reference Type BACKGROUND
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Dias JJ, Bhowal B, Wildin CJ, Thompson JR. Carpal tunnel decompression. Is lengthening of the flexor retinaculum better than simple division? J Hand Surg Br. 2004 Jun;29(3):271-6. doi: 10.1016/j.jhsb.2004.01.011.

Reference Type BACKGROUND
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Karlsson MK, Lindau T, Hagberg L. Ligament lengthening compared with simple division of the transverse carpal ligament in the open treatment of carpal tunnel syndrome. Scand J Plast Reconstr Surg Hand Surg. 1997 Mar;31(1):65-9. doi: 10.3109/02844319709010507.

Reference Type BACKGROUND
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Saravi MS, Kariminasab MH, Bari M, Ghaffari S, Razavipour M, Daneshpoor SM, Yazdi MV, Davoudi MM, Azar MS. A Comparison of Hand Pain and Hand Function after Z-plasty Reconstruction of the Transverse Carpal Ligament with Traditional Median Neurolysis in Carpal Tunnel Syndrome. Arch Bone Jt Surg. 2016 Apr;4(2):145-9.

Reference Type BACKGROUND
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Netscher D, Steadman AK, Thornby J, Cohen V. Temporal changes in grip and pinch strength after open carpal tunnel release and the effect of ligament reconstruction. J Hand Surg Am. 1998 Jan;23(1):48-54. doi: 10.1016/S0363-5023(98)80088-9.

Reference Type BACKGROUND
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Faour-Martín O, Martín-Ferrero MA, Valverde JA, Zuil-Acosta P, Amigo-Liñares L, Alarcón-García J, De la Red MA. The Simonetta Technique for Carpal Tunnel Syndrome: Immediate Postoperative Evaluation and Long-Term Comparative Study. Int Journal of Orthopaedics. 2014 1(3): 109-115

Reference Type BACKGROUND

Zhang X, Li Y, Wen S, Zhu H, Shao X, Yu Y. Carpal tunnel release with subneural reconstruction of the transverse carpal ligament compared with isolated open and endoscopic release. Bone Joint J. 2015 Feb;97-B(2):221-8. doi: 10.1302/0301-620X.97B2.34423.

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PMID: 25628286 (View on PubMed)

Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993 Nov;75(11):1585-92. doi: 10.2106/00004623-199311000-00002.

Reference Type BACKGROUND
PMID: 8245050 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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STCOT

Identifier Type: -

Identifier Source: org_study_id

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