***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 Background Carpal tunnel syndrome is common among employed persons . Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational population s. We aim ed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population . Methods In Skåne region in Sweden we identified all subjects , aged 17–57 years , with new physician-made diagnosis of carpal tunnel syndrome during 5 years ( 2004–2008 ) . For each subject we r and omly sample d , from the general population , 4 matched reference subjects without carpal tunnel syndrome ; the two cohorts comprised 5456 and 21,667 subjects , respectively ( 73 % women ; mean age 43 years ) . We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis . Of those with carpal tunnel syndrome 2111 women ( 53 % ) and 710 men ( 48 % ) underwent surgery within 24 months of diagnosis . We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery . Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort . A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12 % of the women ( n = 492 ) and 11 % of the men ( n = 170 ) and with surgery in 53 % ( n = 1121 ) and 58 % ( n = 408 ) of the surgically treated , respectively ; median duration in conjunction with surgery was 35 days ( IQR 27–45 ) for women and 41 days ( IQR 28–50 ) for men . Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis . Gender differences were small 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 OBJECTIVE To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome . METHODS A prospect i ve , r and omized study was performed on 70 h and s in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004 . Either open ( 36 h and s in 30 patients ) or endoscopic ( 34 h and s in 32 patients ) carpal tunnel release was performed r and omly . Symptom improvement , complications , and the time of operation , in-hospital stay , and return to work between the two groups were assessed with average 2 years of follow-up . The  electromyography  was tested pre- and 3 months post-operation . RESULTS There were no significant differences between the two surgical groups with regard to postoperative improvements of symptom , electromyography tests , and the incidence of complications . But it was statistically less in the rate of scar tenderness , the time of operation , in-hospital stay , and return to work in the endoscopic group compared with the open group ( P < 0.05 ) . CONCLUSIONS The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome . And it has the advantages of slight scar tenderness , less operation time , less in-hospital stay , early functional recovery , safety , and high- satisfaction rate compared with open methods A single-blind , r and omized , controlled trial was done to compare the results of carpal tunnel release using classic incision , short incision , or endoscopic technique . In total , 90 consecutive cases were included . Follow-up was 24 weeks . We found a significantly shorter sick leave in the endoscopic group . No significant differences in pain , paraesthesiae , range of motion , pillar pain , and grip strength could be found at 24 weeks of follow-up , although intermediate significant differences were seen , especially in grip strength , in favour of endoscopic technique . No major advantage to using a short incision could be found . There were no serious complications in either group . The results indicate that the endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract In a clinical , retrospectively r and omised study , we compared the results of the operation for a carpal tunnel syndrome when one side only or both sides were simultaneously assessed in one session . Of the 125 patients examined , 47.2 % had both h and s operated on in one session , 52.8 % had only one h and operated on in one session or both h and s in two sessions . We found the bilateral simultaneous operation to be associated with better results concerning earlier return to work , earlier relief of symptoms and better patient satisfaction than the operation on one side only . These are explained by the necessity of using both h and s for daily activities and thus a guaranteed functional follow-up treatment after the bilateral operation . In conclusion , we propose operating on both h and s simultaneously whenever possible , even if the opposite h and presents with only a slight CTS , which would otherwise not be considered for operation yet Abstract Objectives To compare endoscopic and open carpal tunnel release surgery among employed patients with carpal tunnel syndrome . Design and setting R and omised controlled trial at a single orthopaedic department . Participants 128 employed patients aged 25 - 60 years with clinical ly diagnosed and electrophysiologically confirmed idiopathic carpal tunnel syndrome . Main outcome measures The primary outcome was severity of postoperative pain in the scar or proximal palm and the degree to which pain or tenderness limits activities , each rated on a 4 point scale , transformed into a combined score of 0 ( none ) to 100 ( severe pain or tenderness causing severe activity limitation ) . The secondary outcomes were length of postoperative work absence , severity of symptoms of carpal tunnel syndrome and functional status scores , SF-12 quality of life score , and h and sensation and strength ( blinded examiner ) ; follow-up at three and six weeks and three and 12 months . Results 63 patients were allocated to endoscopic surgery and 65 patients to open surgery , with no withdrawals or dropouts . Pain in the scar or proximal palm was less prevalent or severe after endoscopic surgery than after open surgery but the differences were generally small . At three months , pain in the scar or palm was reported by 33 patients ( 52 % ) in the endoscopic group and 53 patients ( 82 % ) in the open group ( number needed to treat 3.4 , 95 % confidence interval 2.3 to 7.7 ) and the mean score difference for severity of pain in scar or palm and limitation of activity was 13.3 ( 5.3 to 21.3 ) . No differences between the groups were found in the other outcomes . The median length of work absence after surgery was 28 days in both groups . Quality of life measures improved substantially . Conclusions In carpal tunnel syndrome , endoscopic surgery was associated with less postoperative pain than open surgery , but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain Background Endoscopic carpal tunnel release with a single portal technique has been shown to reduce sick leave compared to open carpal tunnel release , cl aim ing to be a less invasive procedure and reducing scar tenderness leading to a more rapid return to work , and the purpose of this study was to identify prognostic factors for prolonged sick leave after endoscopic carpal tunnel release in a group of employed Danish patients . Methods The design was a prospect i ve study including 75 employed patients with carpal tunnel syndrome operated with ECTR at two hospitals . The mean age was 46 years ( SD 10.1 ) , the male/female ratio was 0.42 , and the mean preoperative duration of symptoms 10 months ( range 6 - 12 ) . Only 21 ( 28 % ) were unable to work preoperatively and mean sick leave was 4 weeks ( range 1 - 4 ) . At base-line and at the 3-month follow-up , a self-administered question naire was collected concerning physical , psychological , and social circumstances in relation to the h and problem . Data from a nerve conduction examination were collected at baseline and at the 3-month follow-up . Significant prognostic factors were identified through multiple logistic regression analysis . Results After the operation , the mean functional score was reduced from 2.3 to 1.4 ( SD 0.8 ) and the mean symptom score from 2.9 to 1.5 ( SD 0.7 ) . The mean sick leave from work after the operation was 19.8 days ( SD 14.3 ) . Eighteen patients ( 24 % ) had more than 21 days of sick leave . Two patients ( 3 % ) were still unable to work after 3 months . Significant prognostic factors in the multivariate analysis for more than 21 days of postoperative sick leave were preoperative sick leave , blaming oneself for the h and problem and a preoperative distal motor latency . Conclusion Preoperative sick leave , blaming oneself for the h and problem , and a preoperative distal nerve conduction motor latency were prognostic factors for postoperative work absence of more than 21 days . Other factors may be important ( clinical , demographic , economic , and workplace ) in explaining the great variance in the results of sick leave after carpal tunnel release between studies from different countries The techniques used for carpal tunnel release are open surgery , endoscopy and retinaculum repair . Postoperative outcome , however , is often altered by pain , weak 
    Output:
    
Conclusions This review highlights wide variation in reported RTW times after CTR .
Whilst occupational factors may play a role , these were poorly reported , and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR .