Document Type: RESEARCH PAPER

Authors

1 Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran

2 Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran

3 Mazandaran University Of Medical Sciences, Sari, Iran

Abstract

 
 
 
 Background: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome.
 
Methods: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period.
 
Results: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213). But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P<0.001). However, at week 12, no patient complained of hand pain in both groups.
 
Considering hand function, no patient had normal hand grip after the first week, but after three weeks, a significantly higher proportion of patients in the Z-plasty reconstruction group had reached near normal hand grip (76.1% vs. 29.1%;). However, at weeks 6 and 12, the differences were not statistically different between the two groups.
 
Conclusion: We observed significant reduction in hand pain, shorter duration of hand pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL.
 

Keywords

  1. Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population.Arch Intern Med.2011; 171(10):943-4.
  2. Gelfman R, Melton LJ 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome.Neurology. 2009; 72(1):33-41
  3. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population.JAMA.1999; 282(2):153-8.
  4. Akalin E, El O, Peker O, Senocak O, Tamci S, Gulbahar S, et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises.Am J Phys Med Rehabil.2002; 81(2):108-13.
  5. Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome.Cochrane Database Syst Rev.2012; 7:CD010003.
  6. Franklin GM, Haug J, Heyer N, Checkoway H, Peck N. Occupational carpal tunnel syndrome in Washington State, 1984-1988.Am J Public Health.1991; 81(6):741-6.
  7. Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med. 1987; 11(3): 8343-58.
  8. Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, et al. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome.Neurol Sci. 2004; 25(2):48-52.
  9. Radwin RG, Sesto ME, Zachary SV. Functional tests to quantify recovery following carpal tunnel release. J Bone Joint Surg Am.2004; 86-A(12):2614-20.
  10. Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial.Lancet.2009; 374(9695):1074-81.
  11. Naidu SH, Fisher J, Heistand M, Kothari MJ. Median nerve function in patients undergoing carpal tunnel release: pre- and post-op nerve conductions.Electromyogr Clin Neurophysiol.2003; 43(7):393-7.
  12. Bland JD. Treatment of carpal tunnel syndrome.Muscle Nerve.2007; 36(2):167-71.
  13. Seitz WH, Lall A. Open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament. Curr Orthop Pract.2013; 24(1):53-7
  14. Tanner MA, Conrad BP, Dell PC, Wright TW. The effect of an open carpal tunnel release on thumb CMC biomechanics.Adv Orthop.2012; 2012(10):1-4.
  15. Brown RA, Gelberman RH, Seiler J, Abrahamsson SO, Weiland AJ, Urbaniak JR, et al. A prospective, randomized assessment of open and endoscopic methods.J Bone Joint surg.1993; 75(9):1265-75.
  16. Pagnanelli DM, Barrer SJ. Bilateral carpal tunnel release at one operation: report of 228 patients.Neurosurgery. 1992; 31(6):1030-3.
  17. Lee DH, Masear VR, Meyer RD, Stevens DM, Colgin S. Endoscopic carpal tunnel release: a cadaveric study.J Hand Surg Am. 1992; 17(6):1003-8.
  18. Rowland EB, Kleinert JM. Endoscopic carpal-tunnel release in cadavera. An investigation of the results of twelve surgeons with this training model.J Bone Joint Surg Am. 1994; 76(2):266-8.
  19. Saw NL, Jones S, Shepstone L, Meyer M, Chapman PG, Logan AM. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial.J Hand Surg. 2003; 28(5):444-9.
  20. Agee JM, McCarroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am.1992; 17(6):987-95.
  21. Jacobsen MB, Rahme H. A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release.J Hand Surg Br1996; 21(2):202-4.
  22. Macdermid JC, Richards RS, Roth JH, Ross DC, King GJ. Endoscopic versus open carpal tunnel release: a randomized trial.J Hand Surg Am.2003; 28(3):475-80.
  23. Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ.2006; 332(7556):1473-81.
  24. Alves MPT. Transverse mini-incision for carpal tunnel release.Acta ortop Brasil.2011; 19(6):362-7.
  25. Seitz WH, Lall A. Open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament. Curr Orthop Pract.2013; 24(1):53-7.