Abstract
This prospective study was conducted to investigate electrophysiological qualities and patient’s satisfaction of a synovial gliding tissue flap in treating true recurring carpal tunnel syndrome. In 14 patients (11 women, three men), 15 median nerves were included in this retrospective study. For all 15 nerves, motor and sensory nerve conduction velocity, compound muscle action potential, a Visual Analogue Scale-score (VAS-score) questionnaire and an adapted Levine-Test were evaluated pre- and postoperatively. All participants underwent operative neurolysis of the median nerve, which was then enwrapped by a synovial gliding tissue flap. Eleven procedures were completed by integument enlargement. Follow-up period was 12 months. Postoperatively, distal latency decreased significantly by 15.6%. Compound muscle action potential and sensory nerve conduction velocity did not improve significantly. VAS score regarding pain reduced highly significantly with 74.1%. The adapted Levine-Test function score improved highly significantly with 39.2%. The synovial gliding tissue flap lead to an excellent patient’s satisfaction for treating true recurring carpal tunnel syndrome. Primary wound closure should be completed with integument enlargement if needed.
Highlights
All 15 nerves were found to be surrounded by extensive fibrous tissue within the carpal canal; all 15 nerves were covered by a synovial gliding tissue flap subsequent to neurolysis
Epineurotomy and internal neurolysis were performed in nerve number 2 and 9, since these two nerves remained constricted after release of the tourniquet
The synovial gliding tissue flap proved itself to be an excellent method of treating recurring carpal tunnel syndrome (CTS)—provided that wound closure is not performed under pressure [34]
Summary
Large series of nerve releases to treat median carpal tunnel syndrome (CTS) show a complication rate [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] (treatment failure) that varies from 3 to 25% and a reoperating rate of 12% [3,7,8,9,10,11,17]. Multiple neurolysis (external or internal) alone is rarely the appropriate treatment for true recurring carpal tunnel syndrome, because the re-operated nerve is often trapped in fibrous scar tissue resulting from the repeated disintegration of the surrounding gliding tissue [1,7,18,19,20,21]. Most authors complete secondary neurolysis with any type of flap coverage of the median nerve [1,7,11,15,17,22,23,24,25]. The synovial flap method seems to produce inferior results compared to the more frequently applied HTFPF method [3,12,15,17]. Unlike the HTFPF, relatively little has been published about the synovial flap, and we could find only one study, which directly compares these two techniques
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