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Purpose: The surgical treatment of carpal tunnel syndrome (CTS) has been enriched, by different minimally invasive techniques to decompress the median nerve at the wrist as the endoscopic approaches or modified open technique. However, controversy remains about their safety and complication rate. We present the results of our minimally-invasive technique to median nerve release at the wrist. Methods: The study was conducted in the department of Plastic and Reconstructive surgery GMC Srinagar. The patients who underwent treatment for carpal tunnel syndrome from March -2018 to Feb -2022 were the subjects of study. Results: The study included 63 patients, majority of patients were females (55 patients), and median age was 45 years. 16 patients had bilateral disease; right hand was predominantly involved. All the procedures were done under regional anesthesia under Tourniquet control. Average time taken was 15-20 minutes. Most patients returned to normal routine work in 2 to 3 weeks, with immediate and significant relief of symptoms. Complications were recorded in 3 patients, which included mild scar tenderness in two patients and minor hematoma in one patient. Follow up ranged from 6 months to 2 years. No patient required any repeat surgery for incomplete release of carpal tunnel. Conclusion: It is a simple, easy and effective technique, in a setup with limited resources, with all the advantages of an ECTR and having significantly reduced the complications of conventional open surgical techniques. [ABSTRACT FROM AUTHOR]

Background: The measurement of cross-sectional area (CSA) is a diagnostic tool to detect entrapments syndrome. The aim of this study was to compare the clinical outcome in elbows undergoing endoscopic and "in situ" open cubital tunnel release for cubital tunnel syndrome (CuTS) using ultrasound-related changes in the largest CSA of the ulnar nerve. The purpose is to determine the association between clinical outcome and CSA. Methods: From May 2011 to April 2016, 60 patients with CuTS were prospectively followed and not randomly divided in two groups: 30 patients undergoing an endoscopic release (ER) and 30 patients with "in situ" open neurolysis (OR). A sonographic examination was performed by the senior authors at baseline and 3, 6, and 12 months after surgical decompression. Results: CSA values were statistically significantly lower in the ER. Hand grip strength difference with Jamar test was not statistically significant a 12 months (39 kg vs 27 kg). Static-2 point discrimination test difference was only statistically significant lower in the endoscopic group at 3, 6 and 12 months but not clinically relevant (5 mm vs 6 mm). The American Shoulder and Elbow Surgeons—Elbow questionnaire (ASES-e) function score, ASES-e Pain score, and ASES-e Satisfaction score were not statistically significant different between the two groups at 3, 6, and 12 months post operatively. Conclusions: The study confirms that in spite of lower values of CSA in the ER, there is not a statistically significant difference between the two techniques in terms of subjective outcomes. Ultrasound (US) measurements seem to have a limited value in clinical results of patients treated for entrapment neuropathy of the ulnar nerve. Type of study/LOE: Prognostic Level III [ABSTRACT FROM AUTHOR]

Objective: We report a rare case of flexor tenosynovial fistula secondary to endoscopic release of the A1 pulley for treatment of trigger finger., Case Presentation: A 72-year-old woman underwent endoscopic release of the A1 pulleys of her left ring and right middle fingers. Nine days after surgery, the wound at the base of the proximal phalanx of the ring finger (distal portal) remained open and a clear liquid discharge was seen. The volume of discharge increased with active finger motion. However, there was no evidence of infection. The patient was diagnosed with tenosynovial fistula as a complication of endoscopic release of the A1 pulley. At day 30, the fistula and drainage persisted and the condition was managed by surgical excision of the fistula and primary closure. The wound then healed completely., Conclusion: Our report alerts hand surgeons to the potential development of flexor tenosynovial fistula as a very rare complication following endoscopic release of the A1 pulley for the treatment of trigger finger., (Copyright © 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

A study was conducted of the results of endoscopic surgery for De Quervain's disease in 68 patients in the period between 2000 and 2012. We recommend endoscopic method that provides a complete audit of the primary and secondary channels cut retinaculum and decompression tendons. Endoscopic surgery allowed to reach 97% of successful results without relapse. In 66 of 68 patients with de Quervain's disease , after endoscopic release possible to reach full volume extension and flexion without pain. Our results indicate that endoscopic release De Quervain 's disease is a successful operation.

Endoscopic treatment of recalcitrant chronic exertional compartment syndromes (CECS) of the lower leg is rarely reported. Until now, endoscopic release of CECS of the lower leg is described in only 3 papers addressing 48 interventions in 30 patients. A systematic literature analysis was performed comparing endoscopic and minimally invasive lower leg CECS releases. No statistically relevant difference was found between the results of endoscopic (unweighted mean success rate=86.3%) and minimally invasive (unweighted mean success rate=80.0%) CECS release. However, the methodological quality of the analyzed studies is not sufficient and the number of endoscopically treated patients are too low to draw final conclusions. [ABSTRACT FROM AUTHOR]

Introduction: Theoretical advantages of endoscopic cubital tunnel release are the short incision, lower risk of nerve damage, reduced manipulation of the nerve and possible faster recovery. Sources of data: We systematically searched Medline (PubMed),Web of Science and Scopus databases using the following keywords: 'endoscopic ulnar nerve', 'endoscopic cubital nerve', 'endoscopic ulnar compression' and 'endoscopic ulnar neuropathy'. Twenty-one studies were included in this review. The quality of the studies was assessed using the Coleman Methodological Score. Areas of agreement: Endoscopic release is effective for cubital tunnel entrapment and allows adequate visualization of the site of entrapment. There is a negative association between the severity of the compression and reported outcomes. Injury to the medial branch of the antebrachial cutaneous nerve is less frequent thanks to the limited dissection. The most frequent complication is the development of a hematoma. Areas of controversy: It is unclear whether ulnar nerve instability is a contraindication to simple decompression. Growing points: The shorter time to return to work and the cosmetic appearance of the scar can be considered advantages of the endoscopic technique. Areas timely for developing research: There is a need to perform randomized clinical trials with common and validated scoring system with a longer duration of follow-up. The literature pertinent to endoscopic cubital tunnel release is lacking in the evaluation of the learning curve. Further investigations are necessary to assess the role of ulnar nerve instability. [ABSTRACT FROM AUTHOR]

Background: Resistant plantar fasciopathy is a common orthopedic problem. Aim: Comparing two different methods of treatment. Methods: Fifty patients with chronic resistant plantar fasciopathy were divided into two groups. The first included 23 patients treated by endoscopic release of plantar fascia (EPF) and the second included 27 patients treated by injection of platelet-rich plasma (PRP). Results: In the EPF group, the average VAS improved from 8.28 to 2.35. The average AOFAS improved from 65 to 94. In the PRP group, average VAS improved from 8.22 to 2.9 and the average AOFAS improved from 66 to 92. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is a multifactorial compression neuropathy. It is reported to be very common and rising globally. CTS's treatment varies from conservative measures to surgical treatments. Surgery has shown to be an effective method for more severe cases. However few unclear aspects and room for further research and improvements still remains. We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS. The simple algorithm of leaving the choice of the surgical method to surgeons' preference and experience (together with consideration of patients' related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. We suggest that surgeons (unless in presence of precise indications towards endoscopic release) should tend to perform a minimally invasive open approach release, favoring the advantage of a better neurovascular structures visualization (and a consequent higher chance to perform a complete release with long term relief of symptoms) instead of favoring an early reduction (in the first postoperative days) of immobilization and pain. Research towards a universally accepted standardization should be aimed for by the researchers, who have failed to date to sufficiently limit bias and limitations., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no conflict of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Purpose: To study the ulnar nerve in fresh-frozen cadavers as related to endoscopic release of the cubital tunnel and to present a retrospective review of patients treated with decompression via endoscopic visualization. Methods: To further our understanding of relevant anatomy, we dissected 26 cadaver limbs. We paid special attention to fascial membranes as potential sites of constriction as well as the position of nerves, vessels, and aberrant anatomy. These findings facilitated our understanding of the extent of release in 80 patients (92 cases) with endoscopic cubital tunnel simple decompression. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score, Gabel and Amadio score, and grip and pinch strengths. Results: We noted fascial bands proximal to the medial epicondyle in 12 of 26 cadaver specimens, 2 of which could be the so-called arcade of Struthers. We observed a high degree of variability in the anatomy of the flexor pronator aponeurosis distal to the medial epicondyle. Where present (n = 10), medial antebrachial cutaneous nerve branches crossed the ulnar nerve at an average distance of 2.9 cm from the medial epicondyle (range, 1.0–4.5 cm). Aberrant structures were noted in 8 of the 26 specimens, including an anconeus epitrochlearis muscle in 2 specimens, a basilic vein crossing the ulnar nerve in 4 specimens, and an accessory origin of the medial head of the triceps from the medial intermuscular septum in 2 specimens. In the clinical portion of this study, the average Disabilities of the Arm, Shoulder, and Hand score before surgery was 49 (n = 34) and after surgery was 25 (n = 56). The Gabel and Amadio outcome scores were 24 excellent, 40 good, 25 fair, and 3 poor (n = 92). Average follow-up was 8.2 months (range, 0.1–35 mo). Conclusions: Cadaveric dissections shed light on vulnerable anatomical structures during release, including branches of the medial antebrachial cutaneous nerve, ulnar nerve, brachial artery, fascial bands, and basilic vein. The high degree of anatomical variability in this study highlights the advantage of endoscopic visualization in allowing surgeons to minimize surgical trauma. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Background: Carpal Tunnel Syndrome is a common disease affecting Indian patients. Endoscopic carpal tunnel release is a new technique of treatment for this disease. This study aims to compare the advantages and disadvantages of endoscopic and open carpal tunnel release. Materials and methods: Open technique was performed in 40 patients and endoscopic technique in 35 patients who had clinical signs and symptoms consistent with carpal tunnel syndrome. They had not responded to or had refused non operative management and had Nerve conduction studies consistent with Carpal Tunnel Syndrome. Follow-up evaluations were performed at one week, 3 weeks, 6 weeks and 6 months. During this follow up period both showed similar results. The symptoms of carpal tunnel syndrome were relieved in 39 (98 per cent) of 40 hands in the open release group compared with 34 (97 per cent) of 35 hands in the endoscopic release group. The patients post operative pain was graded from 0 to 10. Patients with grades below 5 averaged 79 per cent in the open-release group compared with 89 per cent in the group that had endoscopic release. Results: Thirty-two (80 per cent) of 40 hands in the open-release group and 20 (57 per cent) of 35 hands in the endoscopic-release group were tender at 1 week. 25 of 40 hands were tender in open release and 10 of 35 hands were tender at 3 weeks. 20 of 40 hands were tender in the open group while 1 of the 35 hands were tender at 6 weeks in the endoscopic release group. 10 of 40 hands in open release had thickened scars while no patients had thickened scar at 6 months in endoscopic group. The open method also resulted in a longer interval until the patient could return to work (twenty days for the open release group vs ten days for endoscopic-release groups). Conclusion: This study shows that two portal endoscopic release of carpal tunnel is a better treatment option for Indian patients with carpal tunnel syndrome. This will become more popular when more surgeons become well trained in doing this technique. [ABSTRACT FROM AUTHOR]

Summary: Superficial radial nerve injury, incomplete release of the first extensor compartment, palmar subluxation of the tendons and painful scar are the main reasons for persistent pain and dysfunction after open release. We therefore asked whether the endoscopic release of the first extensor compartment is advantageous over the open release in terms of subjective pain and disability, complication and aesthetic appearance. Methods: Fifty wrists treated with either open release (26 wrists) or endoscopic release (24 wrists) of the first extensor compartment in case of de Quervain’s disease were included. All patients were evaluated at a minimum of 1-year follow-up using visual analogue scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. Results: The average operating time of endoscopic release was 4 min longer than that of open release. The mean VAS pain score was improved from an initial 6.4 to 0.5 in the open release group and from 6.7 to 0.1 in the endoscopic release group. The mean DASH score was improved from 60.1 to 6.8 in the open release group and from 64.4 to 1.5 in the endoscopic release group. No clinically significant difference was found between the two groups regarding subjective VAS pain and DASH scores at the last follow-up. In the open release group, superficial radial nerve injuries (five wrists), significant scar tenderness (three) and unsightly scar (six) were identified. Conclusions: Endoscopic release of the extensor compartment seems to be an effective and safe procedure in patients with de Quervain’s disease who are unresponsive to non-operative treatments, despite a little increase in operation time. [Copyright &y& Elsevier]

Purpose: To measure pressure within the carpal tunnel (intracarpal tunnel pressures) in patients with carpal tunnel syndrome and determine the effect of quantified active hand use on both the magnitude and location of peak pressures, before and after division of the transverse carpal ligament. Methods: We measured intracarpal tunnel pressures intraoperatively in 12 patients with carpal tunnel syndrome at 5 standardized locations based on the distance between each patient''s proximal pisiform and hook of hamate (HH) before endoscopic division of the ligament, using a semiconductor gauge pressure sensor inserted from proximal to distal into the tunnel under fluoroscopic control. At each location, pressure was recorded with fingers extended, fingers flexed, and 50% maximum grip using a grip dynamometer. Additional hand use activities, including maximum key and pulp pinch using a pinch dynamometer, 25% maximum grip, and maximum grip, were performed by a subset of these patients. After ligament division, we measured pressures during the same hand activities at a single location, HH. We analyzed the effect of hand activity, measurement location, and ligament division using repeated measures analysis of variance. Results: Compared with fingers extended (mean pressure, 56 mm Hg), all pinch and grip activities caused significant increases in pressure at HH, with a mean peak pressure of 1151 mm Hg during maximum grip. After endoscopic release, pressures decreased significantly at HH for all hand activities. Conclusions: In patients with carpal tunnel syndrome, intracarpal tunnel pressures during active hand use are substantially greater than previously reported. Peak pressures occur at the HH, where the tunnel is most constricted and the median nerve is most compressed in carpal tunnel syndrome. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Purpose: To compare the perioperative kinematic effects of endoscopic versus open carpal tunnel release on longitudinal excursion (gliding) and volar displacement (bowstringing) of the median nerve at the wrist region in patients with idiopathic primary carpal tunnel syndrome. Methods: Sixteen hands of 13 patients were randomly assigned into 2 groups (group 1, endoscopic; group 2, open carpal tunnel release). For the measurement of gliding and bowstringing of the median nerve, a metallic marker was used. Before and after the division of the transverse carpal ligament, longitudinal excursion and volar displacement of the median nerve were calculated based on fluoroscopic imaging for each wrist. Movement was analyzed for the measurement of the marker locations. Results: The mean prerelease median nerve excursion during wrist range of motion was 20 mm (range, 10–28) in group 1 and 21 mm (range, 16–31 mm) in group 2. The mean postrelease median nerve excursion during wrist range of motion was 20 mm (range, 13–29) in group 1 and 18 mm (range, 8–26 mm) in group 2. There was no statistically significant difference in pre- and postrelease longitudinal excursion changes between the groups (p = .916 and p = .674, respectively). The mean prerelease volar displacement of the median nerve during wrist range of motion was 3 mm in group 1 and 4 mm in group 2; the postrelease mean values were 2 mm and 5 mm, respectively. There was no statistically significant difference between the groups with regard to pre- and postrelease volar displacement changes of the median nerve (p = .372 and p = .103, respectively). Conclusions: This study demonstrated that the endoscopic release and open carpal tunnel release produce similar perioperative effects on longitudinal and volar movements of the median nerve. [Copyright &y& Elsevier]

Carpal tunnel syndrome (CTS) is still today the most common nerve entrapment syndrome at the level of the upper extremity. When surgery is indicated, the surgical treatment of choice is the opening of the retinaculum. The authors describe their experience on 12,702 carpal tunnel decompressions, by the endoscopic procedure in a period of 14 years, outlining the indications, post-operative treatment, complications and results. [ABSTRACT FROM AUTHOR]

Endoscopic treatment of intractable chronic anterior and lateral exertional compartment syndromes of the lower leg in athletes is reported anecdotically only in six patients. H0 = There is no difference between preoperative and postoperative status after endoscopic release of chronic exertional compartment syndromes of the lower leg. Case series; level of evidence, 4. We developed a minimally invasive, endoscopically assisted technique for release of chronic exertional compartment syndromes of the lower leg. All patients were investigated by telephone interview 47 months (range 5 months–7 years) after surgery. This investigation comprises release of 19 deep posterior, 16 anterior, and 3 lateral compartments in 17 athletes. No complications were seen following endoscopic anterior and lateral compartment decompression, while two patients following deep posterior compartment release underwent open revision surgery due to hemorrhage. Initial endoscopic surgery in these two patients was performed under tourniquet. There were no postoperative complications due to vascular injuries in all further patients who were operated without tourniquet. Ten patients returned to previous sport activity. At follow-up, results were good or excellent in 10 out of 17 patients. Visual analogue pain scale ranged from 5 to 9 (mean 7.4) before surgery and from 1 to 8 (mean 2.4) at follow up ( P = 0.0005). This study confirms feasibility of endoscopic release for chronic exertional compartment syndromes of the lower leg on a larger scale. At least for the deep posterior compartment its safety and effectiveness cannot be recommended without stint as results are inferior as compared to data obtained from literature for open surgery. To avoid vascular complications, especially during deep posterior compartment fasciotomy it is most important to perform the procedure without tourniquet. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is often work-related and associated with prolonged disability. While surgical treatment is common, an alternative endoscopic procedure has been promoted as a way of achieving better outcomes. However, little is known about typical use of the procedure and whether it actually achieves outcomes in community settings. From workers' compensation claims reported to an insurer in six jurisdictions during 1995–1999, we identified 1697 individuals with a single CTS surgery, 17% were treated using the endoscopic procedure. Bivariate analyses of post-surgical outcomes demonstrated that post-surgical work disability was shorter for those with endoscopic procedures (median 27 vs. 34 days, mean 62 vs. 85 days; p< 0.01). Medical costs following the procedure were also lower in the case of endoscopic procedure for those with any post-surgical medical costs (median $1,201 vs. $1,717, mean $5,733 vs. $7,084; p< 0.01). However, controlling for jurisdiction and other factors, these differences disappeared, suggesting that in CTS the type of care received was not a major determinant of outcomes. These findings reinforce the importance of community-based evaluations which include potential confounders to accurately evaluate the impact of medical technologies on work disability in occupational conditions. [ABSTRACT FROM AUTHOR]

Summary: Congenital muscular torticollis is due to fibrosis of one or both the heads of sternocleidomastoid muscle. This may also involve the platysma, scalene muscles, and the carotid sheath and may be associated with cervical scoliosis. Conventional surgical procedures leave visible scars. Ramirez, who used the posterior part of the traditional face-lift incision, made perhaps the first attempt at concealing scars. Burstein et al. reported a large series of subcutaneous endoscopic release of torticollis through a hairline approach. Sasaki described an endoscopic two-incision, posterior auricular fold and hairline approach. A technique of transaxillary subcutaneous endoscopy for the release of the sternocleidomastoid muscle in congenital muscular torticollis is described here. This procedure provides direct access to the fibrous bands, enables release without risk of damage to the spinal accessory nerve, external jugular vein, or greater auricular nerve, and leaves no visible neck scars. Two cases of congenital muscular torticollis presenting in adulthood were managed successfully by this technique. The fibrotic part of sternocleidomastoid muscle was released and the normal range of head motion was restored. There were no surgical complications encountered and the patients achieved complete pain free range of movement in six weeks. This technique provides direct and quick access, perpendicular to the line of the fibrotic bands, avoids injury to neurovascular structures and does not leave visible neck scars. [Copyright &y& Elsevier]

Purpose: The goal of this descriptive study was to investigate the anatomy of the carpal tunnel with respect to the related neurovascular structures, because a detailed knowledge of the complex anatomy of this region is essential to perform endoscopic carpal tunnel release. Methods: Sixteen fresh-frozen cadaveric hands were used for the study. Dissection of the palmar aspect of the hand was performed by use of magnifying loupes, an operative microscope, and microsurgical instruments. All anatomic components were photographed, and dimensions were recorded by use of a micrometer. The distance from the radial aspect of the os pisiformis and the proximal and distal portals to the main structures that may be injured was measured. Topography of the transverse ligament and possible adhesions to the tendons and median nerve were also recorded. Results: The mean distance from the radial aspect of the os pisiformis to the radial border of Guyon’s canal and the ulnar edge of the palmaris longus tendon was 10.3 mm (range, 9 to 12 mm) and 16.1 mm (range, 12 to 22 mm), respectively. The mean distance from the distal portal to the superficial palmar arch and the ulnar artery was 10.4 mm (range, 5 to 15 mm) and 7.6 mm (range, 4.5 to 9 mm), respectively. The mean distance from the distal edge of the transverse ligament to the thenar branch of the median nerve was 2.7 mm (range, 0 to 4.1 mm). The mean length of the transverse ligament was 31 mm (range, 25 to 34.5 mm). In 14 hands we also identified the palmaris longus tendon. In 11 hands we found adhesions between the transverse ligament and the sheath of the flexor tendons. Conclusions: The palmaris longus can be used as a guide for the placement of the proximal portal. Staying at the ulnar side of the palmaris longus keeps the superficial palmar branch of the median nerve at a safe distance from the instruments. The “fat drop sign” is also a useful guide for the placement of the distal margin of the transverse carpal ligament, keeping the distal portal away from the superficial palmar arch. Synovial adhesions can usually cover the inferior surface of the transverse ligament, and they need to be removed for clear endoscopic identification of the transverse fibers before the ligament is cut. Clinical Relevance: Detailed knowledge of the complex anatomy of the carpal tunnel is essential to perform endoscopic carpal tunnel release. [Copyright &y& Elsevier]

Purpose: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. Type of Study: Prospective consecutive series of patients. Methods: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30° arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect. Results: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity. Conclusions: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures. Level of Evidence: Level IV. [Copyright &y& Elsevier]

The overall success rate of surgical interventions for cubital tunnel syndrome is reported to be within 80% to 90% (Szabo, 1999). The discussion, however, whether to perform in situ nerve decompression or anterior transposition continues. In this paper, we present the results of our endoscopic approach to in situ cubital tunnel release, its rationale, clinical and anatomical indications and a detailed description of the technique. [Copyright &y& Elsevier]

Medical treatment of compensated work-related conditions has two objectives-improve injured workers' health status and allow safe and sustained return to work (RTW). Theoretically, the choice of treatment method should be based primarily on these objectives. Surgical treatment of work-related carpal tunnel syndrome (CTS) provides an opportunity to evaluate whether this occurs. The traditional method of open release has been complemented by an endoscopic procedure, particularly useful in work-related cases due to the anticipated benefit of earlier RTW. The objective of this study was to investigate the differences in surgical treatment for work-related CTS across eight US workers' compensation (WC) jurisdictions, and the factors associated with these differences. From all WC claims reported to a single insurer during the 1995–1999 period, we identified individuals with a one or two surgical procedures for work-related CTS. Among selected individuals (n=4,421), about 20% were treated using the endoscopic procedure; this percentage had a ten-fold variation across the eight jurisdictions. However, utilization of endoscopic release did not increase during the study period, despite reports of better RTW outcomes. The highly jurisdictional nature of the US WC system, with significant differences in reimbursement levels for endoscopic procedures, and geographical differences in medical training were among the potential contributors to the observed variation in utilization. [ABSTRACT FROM AUTHOR]

Abstract: We present a new concept in outcome measurement namely “sifting”, which we demonstrate in a series of endoscopic carpal tunnel releases on 72 patients. Each patient is evaluated by considering three groups of criteria. The criteria in the first group are evaluated by the patients themselves (self-evaluation), those in the second group are evaluated by a medical observer (clinical examination) and those in the third group are evaluated by the community (socio-professional aspects). We consider that the global outcome result is good only if it is good at the same time from the point of view of the patient himself, from the point of view of the medical observer and from the point of view of the community. The originality of this “sifting” concept consists in sorting the global outcomes according to a principle of elimination. When the global outcome of each patient is passed through the sieve, this total result is considered as “poor” if only one of the three groups is noted as having a bad result. By applying this original principle to our series, we obtained 11 bad self-evaluated results (reduction in the preoperative DASH lower than 10), 6 bad clinical results (persistence of awkward paraesthesiae) and 1 bad socio-professional result (absence of return to work). After sifting all the patients the poor results represented 14 patients (19 %). It seems to us that this sifting principle represents an advance compared to existing evaluation forms, which do not independently consider these three points of view, and which provide a total score by means of arithmetic operations with arbitrary coefficients. [Copyright &y& Elsevier]

Methods. We studied 22 patients with diagnosis of carpal tunnel syndrome, a total of 27 surgeries. All patients was made a full clinical history included positive signs Tinel, Phalen, and electromiographic study for confirmation. All the patients were treated with endoscopic release. The patients were followed up from 6 to 18 months, and the evaluation was made for an external doctor. Results. The dominant hand was right 18 (66.6%) 19 women and 3 men; 15 (55.5%) patients were workers, and 12 (44.4%) home workers, just two patients had a previous illness like diabetes mellitus and hypothyroidism. The electromyographic preoperative study showed 20 (74%) neuropraxies y 7 (25.9%) axonotmesis, and the final control showed 12 (60%) normal, just one axonotmesis was changed to neuropraxie, and other axonotmesis was reported normal. The satisfaction of the patients was valorated with an analogous scale and the results: 3 (11.1%) surgeries were excellent, 18 (66.6%) with good results, 3 (11.1%) regular and 3 (11.1%) with poor results. Conclusion. We observed the endoscopic release is a good technique, is effective, reduces the morbility. And it reduces the complications of open surgery and the satisfaction of the patients is good. [ABSTRACT FROM AUTHOR]

The results of open carpal tunnel release using a short incision (2.5 cm) have been compared with those following a long incision (4.5 cm) in a prospective randomized study. Eighty patients were operated upon with a follow-up rate of 100%. The variables examined included grip strength, key and pulp pinch strength, sensory function and scar tenderness. Subjective variables such as tingling, numbness and night symptoms were specifically enquired into, and time for return to work was noted. The examinations took place pre-operatively, as well as one, two, three and six weeks post-operatively. Median time for return to work was 21 days for the short incision group and 18 days for the long incision group. The long incision resulted in a significant 10% loss of strength only at week three, otherwise no significant difference was found between the results of the two groups. [ABSTRACT FROM AUTHOR]

Carpal tunnel is the most common peripheral compressive neuropathy. Nonoperative management may provide temporary alleviation of symptoms, but in most cases surgical decompression is warranted. There are a multitude of approaches ranging from open release under general anesthesia to wide awake in-office endoscopic carpal tunnel release. The present article describes the technical considerations for the single incision, antegrade approach to endoscopic carpal tunnel release using the SEGWay system and technique., Competing Interests: Disclosure DP is a minor shareholder in SEGWay Orthopedics, which is a division of Trice Medical. DWP is on the speaker’s bureau for Trice Medical. The remaining authors have no relevant financial disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Exertional compartment syndrome of the forearm is a rare pathology, occurring almost exclusively in motorcycle racers. The results of endoscopic techniques are similar to those of open fasciotomies, but they are less invasive and leave smaller scars. The aim of our study was to present a new endoscopic technique for superficial fasciotomy using the Agee® system and to describe the results. This was a single-center, retrospective descriptive study of 21 patients (36 forearms) operated on between 2006 and 2016. All patients but one were competitive motorcycle racers. The mean operating time was 38.2min (standard deviation (SD), 10.5min). The QuickDASH score was 23.3±10.2% preoperatively versus 1±2% postoperatively (mean±SD). Among the 18 patients who came back for a follow-up visit after 4.9±2.7 years, 17 (94%) were satisfied or very satisfied. The mean time before returning to sport was 4.3 weeks (SD, 1.8 weeks), 9 patients (50%) at the same level as before surgery, 8 (44%) at a higher level, and one at a lower level. There were a few minor complications (superficial vascular lesions, hematoma, transitory hypoesthesia) and symptoms recurred in two patients. Our technique yields outcomes similar to those of other published endoscopic procedures and allows early return to sport. It has the advantage of being based on the Agee endoscope, which is commonly used to treat carpal tunnel syndrome, making the procedure easy to master., (Copyright © 2020. Published by Elsevier Masson SAS.)

Soft tissue sarcomas represent an extremely rare cause of esophageal masses, and undifferentiated sarcomas are rarer. The proportion of dedifferentiated liposarcomas (DDL) is even lower. The case of a 58-year-old male who complained of dysphagia and was found to have an 18-centimeter long esophageal mass/polyp on esophagogastroduodenoscopy is presented. The lesion was resected endoscopically and a diagnosis of DDL was confirmed by fluorescence in situ hybridization. Due to its rarity, the treatment experience with esophageal DDLs is limited. However, based on our experience, endoscopic resection of the lesion can be considered as the treatment of choice when feasible. We performed a review of the literature to identify and analyze similar reported cases., Competing Interests: The authors have declared that no competing interests exist.

Background: Resistant plantar fasciopathy is a common orthopedic problem., Aim: Comparing two different methods of treatment., Methods: Fifty patients with chronic resistant plantar fasciopathy were divided into two groups. The first included 23 patients treated by endoscopic release of plantar fascia (EPF) and the second included 27 patients treated by injection of platelet-rich plasma (PRP)., Results: In the EPF group, the average VAS improved from 8.28 to 2.35. The average AOFAS improved from 65 to 94. In the PRP group, average VAS improved from 8.22 to 2.9 and the average AOFAS improved from 66 to 92., Conclusion: Both methods gave comparable results at late follow-up.