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Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?

View Article: PubMed Central - PubMed

ABSTRACT

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

Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel’s signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed.

Results: 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. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly.

Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.

No MeSH data available.


Graph demonstrating the statistical analysis of pre- and post-operative Quick-DASH scores.
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Figure 1: Graph demonstrating the statistical analysis of pre- and post-operative Quick-DASH scores.

Mentions: When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale by applying Mann-Whitney U test, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05) (Figure 1). Improvements in VAS, symptoms severity scale, and functional status scale did not significantly differ according to whether or not tenosynovectomy and microsurgical epineurectomy were performed during open surgical release of the carpal tunnel.


Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?
Graph demonstrating the statistical analysis of pre- and post-operative Quick-DASH scores.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384317&req=5

Figure 1: Graph demonstrating the statistical analysis of pre- and post-operative Quick-DASH scores.
Mentions: When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale by applying Mann-Whitney U test, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05) (Figure 1). Improvements in VAS, symptoms severity scale, and functional status scale did not significantly differ according to whether or not tenosynovectomy and microsurgical epineurectomy were performed during open surgical release of the carpal tunnel.

View Article: PubMed Central - PubMed

ABSTRACT

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

Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel&rsquo;s signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed.

Results: 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. The average pre-operative two-point discrimination was 6.3&nbsp;&plusmn;&nbsp;2&nbsp;mm in Group-1 and 5.8&nbsp;&plusmn;&nbsp;1.7&nbsp;mm in Group-2. Post-operatively at the end of 12&nbsp;months, the mean two-point discrimination was measured as 5.9&nbsp;&plusmn;&nbsp;1.6&nbsp;mm in Group-1 and 5.6&nbsp;&plusmn;&nbsp;1.3&nbsp;mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p&nbsp;&lt;&nbsp;0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly.

Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.

No MeSH data available.