Carpal tunnel release with subneural reconstruction of the transverse carpal ligament compared with isolated open and endoscopic release

Abstract

We report a new surgical technique of open carpal tunnel release with subneural reconstruction of the transverse carpal ligament and compare this with isolated open and endoscopic carpal tunnel release. Between December 2007 and October 2011, 213 patients with carpal tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to 67) were recruited from three different centres and were randomly allocated to three groups: group A, open carpal tunnel release with subneural reconstruction of the transverse carpal ligament (n = 68); group B, isolated open carpal tunnel release (n = 92); and group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no significant difference between the groups in terms of severity of symptoms or lateral grip strength. Compared with groups B and C, group A had significantly better functional status, cylindrical grip strength and pinch grip strength. There were significant differences in Michigan Hand Outcome scores between groups A and B, A and C, and B and C. Group A had the best functional status, cylindrical grip strength, pinch grip strength and Michigan Hand Outcome score. Subneural reconstruction of the transverse carpal ligament during carpal tunnel decompression maximises hand strength by stabilising the transverse carpal arch.

Platelet-rich plasma injection versus surgical and medical treatment of mild-moderate carpal tunnel syndrome

“…This comes in agreement with Yung-Tsan et al [16] and Zheng et al [4] and their teams as they revealed a similar results, and they reported the gradual sustained improvement of electrophysiological parameters regarding median nerve peak sensory latency and distal motor latency in patients with mild-moderate CTS at 6 months post-injection with platelet-rich plasma and explain that by the role of PRP in facilitation of Schwann cell proliferation, production of neurotrophic, and nerve growth factors with subsequent improvement of nerve electrophysiological parameters.…”

“…Existing evidence-based treatments for carpal tunnel syndrome, splinting, corticosteroid injection, and surgery are not 100% effective, and alternative treatments are worth exploring [2,3]. Surgery indicated in patients with persistent numbness and pain, motor dysfunction with diminished grip or pinch grasping, or thenar eminence flattening [4].…”

Carpal tunnel release with versus without flexor retinaculum reconstruction for carpal tunnel syndrome at short- and long-term follow up—A meta-analysis of randomized controlled trials

“…Five[20, 21, 23–25] of the seven studies used the Simonetta technique to reconstruct the FR, while one study[22] used sub-neural technique and the other one[19] used the Lluch technique. Only one study[22] compared FR reconstruction, open FR release and endoscopic FR release; given that the FR reconstructions were all operated in an open procedure, the endoscopic FR release group was excluded for meta-analysis. Table 1 displays basic characteristics of the pooled RCTs.…”

Applicability of Randomized Trials in Hand Surgery: Survey Study

“…18 studies from high-impact journals 13 - 18 , 21 ,23, 26 , 28 , 29 , 32 - 35 , 37 - 39 (defined as Qualis/CAPES A1, A2, B1, AND/OR impact factor above 1.5);…”