Abstract
Introduction: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome. Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel’s signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. Results: The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly. Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.
Highlights
Carpal tunnel syndrome (CTS), which occurs due to symptomatic compression of the median nerve at the level of wrist joint, is the most common entrapment neuropathy with an estimated prevalence of 3.8% in the general population [1,2,3,4]
Group-1 included 33 wrists of 25 patients treated by performing a standard open surgical release of transverse carpal ligament, whereas Group-2 included 28 wrists of 22 patients treated by performing an open surgical release of transverse carpal ligament combined with flexor tenosynovectomy and microsurgical epineurectomy at the same session
When we compare the forces measured in the pre-operative examination and 12 months after surgery, a 22% increase in grip strength was detected in Group-1 whereas it was 39% in Group-2 (p < 0.05)
Summary
Carpal tunnel syndrome (CTS), which occurs due to symptomatic compression of the median nerve at the level of wrist joint, is the most common entrapment neuropathy with an estimated prevalence of 3.8% in the general population [1,2,3,4]. The pathophysiology involves a combination of mechanical trauma, increased pressure, and ischemic injury to the median nerve within the carpal tunnel [6]. Several studies in the literature demonstrated that abnormalities of the synovial tissue.
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