gms | German Medical Science

Objectives: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and microsurgical epineurectomy for the treatment of idiopathic carpal tunnel syndrome.

Methods: In this prospective study, 61 wrists of 47 patients who undergone surgical treatment for primary idiopathic carpal tunnel syndrome in XXX between March 2009 and October 2012 were randomized to open surgical decompression with or without flexor tenosynovectomy and microsurgical epineurectomy. The patients were randomized into two groups.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. Physical examination including Phalen and Tinel's signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale, Quick Disability of Arm Shoulder Hand Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. Wilcoxon signed-rank test was applied to compare related data of pre-operative and post-operative periods, and nonparametric Mann-Whitney U test to compare independent interval data.

Results and Conclusion: In Group-1, the mean VAS pain score was 8.0 points pre-operatively and it improved to 4.15 points post-operatively (p<0.05). The mean Quick-DASH score also improved from 71.6 points to 50.9 points (p<0.05). The mean symptoms severity score was measured as 3.99 points and functional status score as 2.85 points pre-operatively whereas both were noted as 2.17 points and 2.03 points at 12 months after surgery (p<0.05). In Group-2, the mean VAS pain score was 8.0 points pre-operatively and it improved to 3.39 points post-operatively (p<0.05). The mean Quick-DASH score also improved from 72.7 points to 30.2 points(p<0.05). The mean symptoms severity score was measured as 3.94 points and functional status score as 2.76 points pre-operatively whereas both were noted as 2.12 points and 1.65 points at 12 months after surgery (p<0.05). 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.

In the present study we found that combined flexor tenosynovectomy and microsurgical epineurectomy did not provide advancement of the clinical results in open carpal tunnel decompression for the treatment of idiopathic carpal tunnel syndrome.

In conclusion, we do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open surgical carpal tunnel release in patients with idiopathic carpal tunnel syndrome.