***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 AIM To compare a limited palmar incision for carpal tunnel release ( CTR ) with a traditional open technique , which is still considered the gold st and ard . METHODS Seventy-two patients with a carpal tunnel syndrome were individually r and omized into the trial ( limited incision CTR ) ( n=36 ) and control group ( traditional technique CTR ) ( n=36 ) . In the trial group , skin incision parallel to the thenar crease was made up to 2.5 cm in length , under an operating microscope and endoscopic transillumination . Skin incision in the control group began at the distal border of the carpal ligament , followed the longitudinal crease of the palm , and crossed the base of the palm in a zigzag fashion . Three months after surgery , the patients were asked about symptomatic relief and intervals between the operation and return to their daily activities and work , and examined for scar tenderness and esthetic outcome . Distal motor latency , conduction velocity , scar length , scar width , and operation time were measured . RESULTS There were no differences between the two groups in symptomatic relief and electrophysiological parameters . Intervals between the operation and return to daily activities ( median 5 days , range 2 - 15 ) were shorter in the trial group than in the control group ( median 10 days , range 2 - 21 ; p<0.001 ) , as well as the intervals between the operation and return to work ( median 15 days , range 5 - 45 vs median 30 days , range 10 - 60 ; p<0.001 ) . Scar/pillar tenderness , scar length and width , esthetic outcome , and operation time were significantly better in the trial group . CONCLUSION Limited palmar incision CTR is as effective and safe as traditional CTR technique , but with better postoperative recovery and cosmetic results & 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 Summary In a series of patients with clinical ly and neurophysiologically well defined carpal tunnel syndrome a r and omization has been made into two groups , one for operation with internal neurolysis and a microscopical technique , and the other group for cutting of the carpal ligament ( flexor retinaculum ) alone . The two groups have been compared postoperatively regarding clinical and neurophysiological parameters . All patients improved , 89 % in both groups considered themselves totally free of symptoms at follow-up examinations but there was no significant difference in any parameter between the two groups . As a conclusion the use of internal neurolysis can not be recommended as a routine procedure in carpal tunnel syndrome 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 PURPOSE R and omized clinical trials can provide strong evidence regarding effective treatment options . The quality of reporting and the type of outcome measures used are important when judging whether results justify change in clinical practice . The aim of this study was to assess the quality of reporting of  r and omized clinical trials related to treatment of upper-extremity disorders , published in 4 h and surgical and orthopedic journals during an 11-year period , and assess the type of outcome measures used in the trials . METHODS Eligible articles were identified by review ing all abstract s published in the 4 journals from 1992 through 2002 . The quality of reporting was assessed by a modified Jadad scale that consisted of 3 items ( r and omization , blinding , and withdrawals/dropouts ) . A higher score ( 0 - 5 ) indicated higher quality . The outcome measures were classified according to the International Classification of Functioning , Disability and Health into the levels of body function and structure , activity , and participation . RESULTS Of 92 articles reporting r and omized clinical trials , 40 articles described appropriate r and omization method that implied they were truly r and omized studies , 31 articles did not describe the r and omization method , and 21 articles ( 23 % ) described inappropriate r and omization methods . Double or single blinding was reported in 33 articles . Absence or description of withdrawals/dropouts was shown in 77 articles . The median quality score calculated for all 92 articles was 2 ( range , 0 - 5 ) points . The median score for the 28 articles published 1992 through 1996 was 1 ( range , 0 - 5 ) points and for the 64 articles published from 1997 through 2002 was 3 ( range , 0 - 5 ) points . All trials used outcome measures on body function and structure level ; 41 % used measures of activity and /or participation . CONCLUSIONS There is a need to improve the quality of reporting of upper-extremity r and omized clinical trials and 
    Output:
    
The most frequently assessed outcomes were self-reported symptom resolution , grip or pinch strength and return to work .