***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess the efficacy of an adjunctive epineurotomy in carpal tunnel syndrome , 36 wrists in 33 patients were prospect ively r and omized into epineurotomy and non-epineurotomy treatment groups . The operating surgeons and evaluating therapist were double-blinded . Patients were evaluated preoperatively and at either 6 or 12 months postoperatively , with 15 patients examined at both postoperative time points . Evaluation consisted of five sensory and four motor tests : static and moving two-point discrimination , Semmes-Weinstein monofilament testing , vibratory ( 30 and 256 cps ) sensibility , and dynamometer testing of grip strength and lateral , three-jaw , and tip pinch strengths . Sensory testing showed overall improvement within both groups postoperatively , but there was no difference between the two groups at either 6 or 12 months postoperatively . Motor testing revealed no improvement in the grip strength or lateral , three-jaw , or tip pinch of either group at 12 months when compared to preoperative levels . Twenty-four of 26 epineurotomy patients and all 10 control patients were satisfied with their clinical outcome 30 months after surgery . The addition of an adjunctive epineurotomy , although safe , offered no clinical benefit in the surgical treatment of carpal tunnel syndrome in this series A 10-center r and omized prospect i ve multicenter study of endoscopic release of the carpal tunnel was carried out . Surgery was performed with a new device for transecting the transverse carpal ligament while control h and s were treated with conventional open surgery . There were 122 patients in the study ; 25 had carpal tunnel surgery on both h and s and 97 had surgery on one h and . Of the surgical procedures , 65 were in the  control  group and 82 were in the device group . The endoscopic device was coupled to a fiberoptic light and a video camera . A trigger-activated blade was used to incise the transverse carpal ligament . After surgery , the best predictors of return to work and to activities of daily living were strength and tenderness variables . For patients in the device group with one affected h and , the median time for return to work was 21 1/2 days less than that for the control group . Two patients treated with the endoscopic device required reoperation by open surgical decompression ; only one of these had incomplete release with the device . Two patients in the device group experienced transient ulnar neurapraxia & NA ; Endoscopic carpal tunnel release has been cl aim ed to offer improvement in recovery time and postoperative discomfort over open carpal tunnel release . Short‐incision open carpal tunnel release has been cl aim ed to offer recoveries comparable with endoscopic techniques . Patients receiving carpal tunnel surgery were r and omized to short‐incision open release or single‐portal endoscopic release .  Preoperative and postoperative evaluation included grip and pinch strength measurements and patient completion of a question naire regarding symptoms and function . Thirty‐six operated h and s completed evaluation , including 22 endoscopic and 14 open releases . Early grip and pinch strength  after endoscopic carpal tunnel release  were improved significantly over short‐incision open release ( p < 0.05 ) . Subjective evaluation indicated a trend toward improved symptoms and function with endoscopic over short‐incision open carpal tunnel release . Endoscopic carpal tunnel release provides faster recovery of strength  than short‐incision open carpal tunnel release and improves early postoperative comfort and function to a small degree . Mackenzie DJ , Hainer R , Wheatley MJ . Early recovery after endoscopic vs. short‐incision open carpal tunnel release . Ann Plast Surg An operative technique of  carpal tunnel release  using intraoperative ultrasonography is described . In this technique , " safe line " is defined in the transverse carpal ligament and the adjacent deep forearm fascia midway between the ulnar margin of the median nerve and the radial margin of the ulnar artery . After ultrasonographic design of a 1.0 to 1.5-cm skin incision along the safe line at the distal carpal tunnel , the distal ligament is released under direct vision . Proximal release is performed along this line under ultrasonographic monitoring using a device that consists of a basket punch and an outer metal tube . In a prospect i ve r and omized study , the outcomes were compared for carpal tunnel release using either this technique in 50 h and s of 50 patients or conventional open release in 53 h and s of 53 patients . Follow-up assessment at 3 , 6 , 13 , 26 , 52 , and 104 weeks showed no significant difference with respect to numbness and paresthesias , static two-point discrimination , findings on Semmes-Weinstein monofilament testing , findings on manual muscle testing of the abductor pollicis brevis , and electrophysiologic findings . The ultrasonographic-release group had better outcomes regarding pain , tenderness of the scar , and key-pinch strength at 3 , 6 , and 13 weeks , and grip strength at 3 and 6 weeks after surgery . The scar was more aesthetic in this group . There were no complications with either technique The advantages and disadvantages of endoscopic compared with open carpal tunnel release are controversial . We have performed a prospect i ve , r and omised , blinded assessment in a district general hospital in order to determine if there was any demonstrable advantage in undertaking either technique . Twenty-five patients with confirmed bilateral idiopathic carpal tunnel syndrome were r and omised to undergo  endoscopic release by the single portal Agee technique to one h and and open release to the other . Independent preoperative and postoperative assessment was undertaken by a h and therapist who was blinded to the type of treatment . Follow-up was for 12 months . The operating time was two minutes shorter for the open technique ( p < 0.005 ) . At all stages of postoperative assessment , the endoscopic technique had no significant advantages in terms of return of muscle strength and assessment of h and function , grip strength , manual dexterity or sensation . In comparison with open release , single-portal endoscopic carpal tunnel release has a similar incidence of complications and a similar return of h and function , but is a slightly slower technique to undertake This prospect i ve , r and omized study compares two treatment methods in patients with primary carpal tunnel syndrome .  Decompression of the transverse carpal ligament was done in thirty-two h and s ( thirty patients ) and decompression of the transverse carpal ligament with the addition of an internal neurolysis of the median nerve was done in thirty-one h and s ( twenty-nine patients ) . Relief of symptoms was described in eighty-eight percent of the patients with carpal ligament release and eighty-one percent of patients with carpal ligament release plus internal neurolysis . Improvement in h and sensibility testing , in thenar muscle strength , and atrophy was noted in both treatment groups with no statistical difference between groups . The addition of an internal neurolysis to division of the transverse carpal ligament does not add significant improvement in the sensory or motor outcome of patients with primary carpal tunnel syndrome We conducted a prospect i ve , r and omized study to evaluate the effect of epineurotomy on the outcome of operative treatment of established median-nerve compression in the carpal canal . Fifty h and s ( forty-four patients ) were r and omized into two groups : one group had a  release of the transverse carpal ligament alone , and the other had a release and adjuvant epineurotomy of the median nerve . The groups were similar with regard to age , gender , duration of symptoms , and preoperative physical findings . All patients had electrophysiological evidence of sensory delays and fibrillations on preoperative testing . All of the operative procedures were performed by the same surgeon . The patients were evaluated preoperatively and at one year postoperatively . The follow-up examination revealed no detectable differences between the two groups with regard to symptoms , objective findings , or electrophysiological findings . This suggests that epineurotomy of the median nerve offers no benefit compared with sectioning of the transverse carpal ligament alone A r and omized prospect i ve study was carried out to compare one-portal endoscopic carpal tunnel release with an open procedure . There were 47 patients ( mean age 52.6 years ) : 25 underwent an endoscopic and 22 an open release .  The aim of the study was to evaluate the risks against the benefits for pain , grip , key-pinch strength and ability to return to work . The distribution of age , occupation , sex , neurographic findings and operated h and was similar in both groups . We detected no serious nerve complications . One “ open ” patient developed a hypertrophic scar , a second “ open ” patient a disabling reflex sympathetic dystrophy , one “ endo ” patient a transient neurapraxia . The remaining patients experienced complete relief of symptoms . Improvement of grip strength is significantly better after endoscopic release ( P=0.0001 at 3 months ) . In contrast , the key-pinch showed a similar pattern of improvement in both groups . The ability to use the operated h and as effectively as the contralateral one developed after 24 days for the endoscopic group versus 42 for the open approach ( P=0.0000 ) . The carpal arch alteration was less important for the endoscopic group ( P= 0.013 ) , but without any correlation with the grip strength . Agee 's one-portal technique only allows correct placement of a knife , not an inspection of the structures being operated upon . This is a major limitation , reducing the surgeon to a technician . Further development of this procedure dem and s a device that will enable a fruitful inspection of the carpal tunnel CONTEXT Carpal tunnel syndrome ( CTS ) is a cause of pain , numbness , and tingling in the h and s and is an important cause of work disability . Although high prevalence rates of CTS in certain occupations have been reported , little is known about its prevalence in the general population . OBJECTIVE To estimate the prevalence of CTS in a general population . DESIGN General health mail survey sent in February 1997 , inquiring about symptoms of pain , numbness , and tingling in any part of the body , followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the h and s , as well as of a sample of those not reporting these symptoms ( controls ) . SETTING A region in southern Sweden with a population of 170000 . PARTICIPANTS A sex- and age-stratified sample of 3000 subjects ( age range , 25 - 74 years ) was r and omly selected from the general population register and sent the survey , with a response rate of 83 % ( n = 2466 ; 46 % men ) . Of the symptomatic responders , 81 % underwent clinical examination . MAIN OUTCOME MEASURES Population prevalence rates , calculated as the number of symptomatic responders diagnosed on examination as having clinical ly certain CTS and /or electrophysiological median neuropathy divided by the total number of responders . RESULTS Of the 2466 responders , 354 reported pain , numbness , and /or tingling in the median nerve distribution in the h and s ( prevalence , 14.4 % ; 95 % confidence interval [ CI ] , 13.0%-15.8 % ) . On clinical examination , 94 symptomatic subjects were diagnosed as having clinical ly certain CTS ( prevalence , 3.8 % ; 95 % CI , 3.1%-4.6 % ) . Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects ( prevalence , 4.9 % ; 95 % CI , 4.1%-5.8 % ) . Sixty-six symptomatic subjects had clinical ly and electrophysiologically confirmed CTS ( prevalence , 2.7 % ; 95 % CI , 2.1%-3.4 % ) . Of 125 control subjects clinical ly examined , electrophysiological median neuropathy was found in 23 ( 18.4 % ; 95 % CI , 12.0%-26.3 % ) . CONCLUSION Symptoms of pain , numbness , and tingling in the h and s are common in the general population . Based on our data , 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and  electrophysiologic testing A study of endoscopic carpal tunnel release  was carried out in three parts , consisting of initial cadaveric dissections , a prospect i ve pilot study of 20 patients and a prospect i ve , r and omized trial of 71 patients comparing endoscopic with open decompression .  In the main trial , 25 patients with bilateral symptoms underwent simultaneous endoscopic and open release  , with the remainder r and omized to one or other technique . Both techniques effectively decompressed the median nerve . A significant improvement in grip and pinch strength over 3 months was achieved in those undergoing endoscopic surgery .  Average return to work was 14 days in the endoscopic series and 39 days in the open series . A complication rate of 35 % was achieved with the transbursal endoscopic technique , 3.7 % with the extrabursal endoscopic technique and 13.5 % in the open series Two hundred and seventy-three patients with carpal tunnel syndrome without advanced neurophysiological changes ( distal motor latency below 11 ms ) were r and omized to treatment by  open carpal tunnel release with , or without , epineurotomy . Patients were examined clinical ly and by nerve conduction studies preoperatively and at 3 , 6 and 12 months postoperatively . We found no statistically significant difference between simple decompression and decompression combined with epineurotomy with regard to either the clinical or the neurophysiological outcome A r and omized controlled trial was done to compare the results of carpal tunnel decompression using the st and ard open approach and the Knifelight ® technique .  Twenty- 
    Output:
    
Two studies included both power and pinch strength and reported descriptive statistics enabling calculation of effect sizes to compare the relative responsiveness of grip and pinch strength within study sample s. The study findings suggest that tip pinch is more responsive than lateral pinch or power grip up to 12 weeks following surgery for CTS .
Conclusion Although used most frequently and known to be reliable , power and key pinch dynamometry are not the most valid or responsive tools for assessing motor outcome up to 12 weeks following surgery for CTS .
Tip pinch dynamometry more specifically targets the thenar musculature and appears to be more responsive .
Manual muscle testing , which in theory is most specific to the thenar musculature , may be more sensitive if assessed using a h and held dynamometer – the Rotterdam Intrinsic H and held Myometer .