Flexor tenosynovectomy in the treatment of carpal tunnel syndrome: some theoretical and procedural differences.

Abstract

To Editor: I read with interest The Role of Flexor Tenosynovectomy in the Operative Treatment of Carpal Tunnel Syndrome (2002;84:221-5), by Shum et al. finding of no increased rate of morbidity in association with the performance of a flexor tenosynovectomy at the time of carpal tunnel is applaudable because it dispels the myth that flexor tenosynovectomy at the time of carpal tunnel release causes more harm than good. However, the suggestion that routine flexor tenosynovectomy offers no benefit compared with sectioning of the transverse carpal ligament alone for the treatment of idiopathic carpal tunnel syndrome must not go unchallenged because the lack of improvement in outcome for patients treated with flexor tenosynovectomy is undoubtedly related to the authors' inadequate technique. Because of the proximity of the radial synovial bursa to the palmar cutaneous branch of the median nerve proximally and to the motor branch of the nerve distally, the radial synovial bursa has become the proverbial twisted thorn tree that nobody dares to cut down. Consequently, when the literature recommends flexor tenosynovectomy, the procedure involves excision of the ulnar synovial bursa only, which is what …