Endoscopic versus open treatment of carpal tunnel syndrome in patients with rheumatoid arthritis

ABSTRACT 

     

Background:  Rheumatoid arthritis (RA) is a known risk factor for carpal tunnel syndrome,  possibly because the inflammation causes compression of the median nerve. Endoscopic and open carpal tunnel release (ECTR and OCTR) have been studied extensively in the general population but less so in patients with RA. The purpose of our study was to analyze outcomes and patient-specific comorbidities associated with ECTR and OCTR in patients with RA.  

 

Methods: We conducted a retrospective cohort study using the PearlDiver database to identify patients with RA who underwent either ECTR or OCTR between 2010 and 2014. Demographic data, comorbidities, and complication rates were analyzed. We used univariate and multivariable analysis to assess differences between the treatment methods. 

 

Results:  Comparing 4234 patients who underwent OCTR to 683 patients who underwent ECTR, we found no significant differences in medical comorbidities such as hypertension, obesity, chronic kidney disease, hypothyroidism, and diabetes mellitus. Patients who underwent ECTR were significantly more likely to require a repeat procedure within 90 days of the initial procedure. However, this difference was not consistent in multivariate analysis controlling for comorbidities. 

 

Conclusion: Our study found that RA and ECTR were identified as independent risk factors for revision release, with ECTR showing a higher likelihood of repeat procedures within 90 days compared to OCTR. Despite similar demographics and comorbidities in the two study cohorts, use of OCTR outpaced ECTR use in the study period. Future research should explore further characterization of repeat procedures in this higher-risk patient subset.