Modified Camitz versus BRAND Procedures for the Treatment of Severe Carpal Tunnel Syndrome: A Comparative Trial Study

Document Type : RESEARCH PAPER


1 Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Carpal tunnel syndrome (CTS) is characterized by complications such as pain, paresthesia, and
numbness in the fingers. There are some surgical therapies for the management of severe carpal tunnel, but differences
exist between the treatments available for creating the opposition. The current study was conducted to compare the
effect of modified Camitz and BRAND techniques on thumb opposition in patients with severe CTS.
Methods: A total of 40 patients with severe CTS who were candidates for opponensplasty were enrolled in this clinical
trial study at Alzahra and Kashani hospitals, Isfahan, Iran, from 2014 to 2018. The patients were divided into two groups
of modified Camitz and BRAND. Quick DASH-9 and Kapandji scores as well as pulp and side pinch and pronation
angle were assessed before and after the surgeries.
Results: Quick DASH-9 score, Kapandji score, pulp and side pinch and pronation angle significantly improved postoperatively
(P=0.0XXX, P=0.0XXX, P=0.0XXX, P=0.0XXX, and P=0.0XXX, respectively). But, no significant differences
were seen in the mentioned variables between both groups pre and post-operative (P>0.05, for all the studied variables).
No postsurgical complications were seen in any of the groups.
Conclusion: The findings of the present study demonstrated that, both Modified Camitz and BRAND techniques
are effective and safe techniques, yielding high improvements, but no serious complications. Both techniques can be
considered for treatment of patients with severe CTS.
Level of evidence: II


1. Bland JD. Carpal tunnel syndrome. Curr Opin Neurol.
2005; 18(5):581-5.
2. Abbasi S, Ghasemi M, Khorvash F, Ghadimi K,
Madahian P. Evaluation of clinical symptoms in
patients with different severities of carpal tunnel
syndrome. Casp J Neurol Sci. 2017; 3(10):143-50.
3. Vasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP,
Brassington R, Scholten RJ, et al. Endoscopic and 
open release similarly safe for the treatment of
carpal tunnel syndrome. A systematic review and
meta-analysis. PLoS One. 2015; 10(12):e0143683.
4. Hattori Y, Doi K, Sakamoto S, Kumar K, Koide S.
Camitz tendon transfer using flexor retinaculum as
a pulley in advanced carpal tunnel syndrome. J Hand
Surg Am. 2014; 39(12):2454-9.
5. Skie MC, Parent T, Mudge K, Dai Q. Kinematic 
analysis of six different insertion sites for FDS
opponensplasty. Hand. 2010; 5(3):261-6.
6. Moriya K, Yoshizu T, Maki Y. Immediate thumb
opposition following extensor indicis proprius
opponensplasty using the wide-awake approach.
Plast Surg Case Stud. 2016; 2(2):27-30.
7. de Roode CP, James MA, McCarroll HR Jr. Abductor digit
minimi opponensplasty: technique, modifications, and
measurement of opposition. Tech Hand Up Extrem
Surg. 2010; 14(1):51-3.
8. Al-Qattan MM. Extensor indicis proprius
opponensplasty for isolated traumatic low median
nerve palsy: a case series. Can J Plast Surg. 2012;
9. Rymer B, Thomas PB. The Camitz transfer and its
modifications: a review. J Hand Surg EurVol. 2016;
10. Kato N, Yoshizawa T, Sakai H. Simultaneous modified
Camitz opponensplasty using a pulley at the radial
side of the flexor retinaculum in severe carpal tunnel
syndrome. J Hand Surg EurVol. 2014; 39(6):632-6.
11. Kozin SH, Ezaki M. Flexor digitorum superficialis
opponensplasty with ulnar collateral ligament
reconstruction for thumb deficiency. Tech Hand Up
Extrem Surg. 2010; 14(1):46-50.
12. Anderson GA, Lee V, Sundararaj GD. Opponensplasty
by extensor indicis and flexor digitorum superficialis
tendon transfer. J Hand Surg Br. 1992; 17(6):611-4.
13. Sammer DM, Chung KC. Tendon transfers part II:
transfers for ulnar nerve palsy and median nerve
palsy. Plast Reconstr Surg. 2009; 124(3):212e-21e.
14. Wong JY, Fung BK, Chu MM, Chan RK. The use
of disabilities of the arm, shoulder, and hand
questionnaire in rehabilitation after acute traumatic
hand injuries. J Hand Ther. 2007; 20(1):49-55.
15. Ebrahimzadeh MH, Moradi A, Vahedi E, Kachooei
AR, Birjandinejad A. Validity and reliability of the
persian version of shortened disabilities of the arm,
shoulder and hand questionnaire (Quick-DASH). Int
J Prev Med. 2015; 6(1):59.
16. Kapandji A. Clinical test of apposition and counterapposition
of the thumb. Ann Chir Main. 1986;
17. Baluch N, Borschel GH. Use of adjunctive palmaris
longus abductorplasty (Camitz) tendon transfer
in pediatric median nerve injury. J Plast Reconstr 
Aesthet Surg. 2013; 66(5):726-8.
18. Park IJ, Kim HM, Lee SU, Lee JY, Jeong C.
Opponensplasty using palmaris longus tendon and
flexor retinaculum pulley in patients with severe
carpal tunnel syndrome. Arch Orthop Trauma Surg.
2010; 130(7):829-34.
19. Naeem R, Lahiri A. Modified Camitz opponensplasty
for severe thenar wasting secondary to carpal
tunnel syndrome: case series. J Hand Surg Am. 2013;
20. Nobuta S, Sato K, Itoi E. Effects of modified camitz
opponensplasty to restore thumb opposition for
severe carpal tunnel syndrome. Int J Phys Med
Rehabil. 2017; 5(444):2.
21. Wan SH, Wong TC, Yip TH, Ip FK. Clinical experience
of open carpal tunnel release and Camitz operation
in elderly Chinese patients. Hong Kong Med J. 2007;
22. Terrono AL, Rose JH, Mulroy J, Millender LH. Camitz
palmaris longus abductorplasty for severe thenar
atrophy secondary to carpal tunnel syndrome. J
Hand Surg Am. 1993; 18(2):204-6.
23. Foucher G, Malizos C, Sammut D, Braun FM,
Michon J. Primary palmaris longus transfer as an
opponensplasty in carpal tunnel release: a series of
73 cases. J Hand Surg Br. 1991; 16(1):56-60.
24. Mondelli M, Reale F, Padua R, Aprile I, Padua L. Clinical
and neurophysiological outcome of surgery in
extreme carpal tunnel syndrome. Clin Neurophysiol.
2001; 112(7):1237-42.
25. Kamiya H, Kimura M, Hoshino S, Kobayashi M, Sonoo
M. Prognosis of severe carpal tunnel syndrome with
absent compound muscle action potential. Muscle
Nerve. 2016; 54(3):427-31.
26. Uemura T, Hidaka N, Nakamura H. Clinical outcome
of carpal tunnel release with and without opposition
transfer. J Hand Surg EurVol. 2010; 35(8):632-6.
27. de Kraker M, Selles RW, Zuidam JM, Molenaar HM,
Stam HJ, Hovius SE. Outcome of flexor digitorum
superficialis opponensplasty for type II and IIIA
thumb hypoplasia. J Hand Surg Eur Vol. 2016;
28. Lee YS, Cheon HJ, Kim YW, Woo SH. Primary ring flexor
digitorum superficialis transfer with open carpal
tunnel release in extreme carpal tunnel syndrome. J
Korean Soc Surg Hand. 2017; 22(1):34-40.