Should Single-Stage Opponensplasty Be Added at the Time of Release for Severe Carpal Tunnel Syndrome?

Abstract

Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of upper limb. In advanced stage of CTS, nerve conduction studies demonstrate undetectable compound muscle action potentials of the abductor pollicis brevis (APB-CMAP) following stimulation of the median nerve at the wrist. Opponensplasty is a surgical option for patients with severe CTS. Should single-stage opponensplasty be added at the time of release for severe carpal tunnel syndrome? Methods: We prospectively evaluated patients following carpal tunnel release to observe correlation between clinical and electrophysiological recovery and to determine the necessity for single-stage opponensplasty. Subjects were prospectively collected 22 hands from 22 carpal tunnel syndrome patients, with APB-CMAP of 2 mV or less and evaluated preoperatively and postoperatively for clinical and electrophysiological recovery. Results: All 3 components of pulp pinch strength (PPS)—that is, tip-tip, lateral, 3 point; grip strength; and thumb opposition—showed statistical significant improvement after 6 months. There was statistical significant improvement in APB-CMAP postoperatively after 6 months. Functional outcome was assessed with Mayo wrist score and showed statistical significant improvement postoperatively. Conclusion: We conclude that all patients had good clinical and electrophysiological recovery at 6 months; therefore, single-stage opponensplasty may not be necessary for such patients.