Artikel
Long Term Functional Results of Camitz opponensplasty in Severe Carpal Tunnel Syndrome with Severe Thenar Atrophy
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Autoren
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Nash Naam
- Southern Illiniois Hand Center, Southern Illinois University, Effingham, United States
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Abdel Hakim Massoud
- Al Azhar University, Cairo, Egypt
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Introduction: Camitz opponensplasty is a tendon transfer of the palmaris longus tendon to the thumb for patients with loss of thumb opposition and abduction in severe carpal tunnel syndrome. The purpose of this study is to evaluate the long-term functional results of patients with more than 10 years after surgery.
Methods: A retrospective review of patients who had Camitz opponensplasty for more than 10 years was conducted. All patients who had the surgery before 2007 were reviewed. 63 patients had the surgery between 1987 and 2007. 32 patients were available for review. Their age at the time of surgery averaged 68 years (range 58-72).
All patients presented with severe numbness and tingling and complete loss of active thumb abduction or opposition. Electrodiagnostic studies confirmed sever carpal tunnel syndrome and the complete loss of motor unit recruitment in the abductor pollicis brevis muscle. The procedure was combined with open carpal tunnel release.
All patients were evaluated clinically for grip and pinch strength, active range of motion of thumb palmar and radial abduction, sensory evaluation and Kapandji score. No electrodiagnostic studies were performed. DASH score was also obtained.
Results: 31 patients were satisfied with the procedure. Active thumb palmar abduction significantly improved from a preoperative average of 15 degrees to 52 degrees. The grip strength improved from a preoperative average of 42% of the contralateral side to 87% (range 56-92%). Pulp pinch strength improved from a preoperative average of 40% of the contralateral side to 88%.
Kapandji score improved from an average of 2 to a postoperative average of 9.5 (range 8-10).
Semmes-Weinstein Monofilament test showed improvement from an average of 6.65 preoperatively to 3.61 postoperatively.
DASH scores averaged 8 (range 2-23). We did not have preoperative DASH scores to compare with.
When compared with the final values at time of patients' discharge there was a significant improvement of Pinch strength, Kapandji score, Active thumb radial and palmar abduction and return of sensibility.
Conclusions: This study shows that patients have open carpal tunnel release and Camitz opponensplasty continue to improve and maintained the improvement for a long time. Therefore, It is considered a reasonable choice for patients with loss of abduction and opposition of the thumb secondary to severe CTS.
