The objective of this study is to compare the clinical effectiveness of two surgical techniques in patients with severe unilateral idiopathic carpal tunnel syndrome. A total of 117 patients were randomized in two groups. In the experimental group (n = 59) reconstruction of the transverse carpal ligament was performed after open retinaculum release (TCL reconstruction group). In the control group (n = 58) only retinaculum release was performed (TCL release group). The primary outcome measure was grip strength; secondary outcome measures were pain and response to the Boston questionnaire. Significance was analysed using the t-test or Mann–Whitney test. At 6 months, the experimental group showed clinical and statistically significant improvement in grip strength and decrease in symptom severity. Retinaculum release with reconstruction of the transverse carpal ligament results in improvement of grip strength in the medium term when compared with open retinaculotomy in patients with severe unilateral idiopathic carpal tunnel syndrome.
AtroshiIJohnssonRSprinchornA. Self-administered outcome instrument in carpal tunnel syndrome. Reliability, validity and responsiveness evaluated in 102 patients. Acta Orthop Scand. 1998, 69: 82–8.
2.
AulisaLTamburrelliFPaduaRRomaniniELo MonacoMPaduaL. Carpal tunnel syndrome: indication for surgical treatment based on electrophysiologic study. J Hand Surg Am. 1998, 23: 687–91.
3.
BakhshHIbrahimIKhanWSmithamPGoddardN. Assessment of validity, reliability, responsiveness and bias of three commonly used patient-reported outcome measures in carpal tunnel syndrome. Ortop Traumatol Rehabil. 2012, 14: 335–40.
4.
BlandJD. (2000a) A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 23: 1280–3.
5.
BlandJD. (2000b) The value of the history in the diagnosis of carpal tunnel syndrome. J Hand Surg Br. 25: 445–50.
6.
DiasJJBhowalBWildinCJThompsonJR. (2004) Carpal tunnel decompression. Is lengthening of the flexor retinaculum better than simple division?J Hand Surg Br. 29: 269–74.
7.
Garcia-EliasMSanchez-FreijoJMSaloJMLluchAL. Dynamic changes of the transverse carpal arch during flexion-extension of the wrist: effects of the sectioning the transverse carpal ligament. J Hand Surg Am. 1992, 17: 1017–9.
8.
GartsmanGMKovachJCCrouchCCNoblePCBennettJB. Carpal arch alteration after carpal tunnel release. J Hand Surg Am. 1986, 11: 372–4.
9.
GeereJChesterRKaleSJerosch-HeroldC. Power grip, pinch grip, manual muscle testing or thenar atrophy – which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review. BMC Musculoskeletal Disord. 2007, 8: 114.
10.
GreensladeJRMehtaRLBewardPWarwickDJ. (2004) DASH and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire?J Hand Surg Br. 29: 159–64.
11.
HuisstedeBRandsdorpMCoertJGlerumSvan MiddelkoopMKoesB. Carpal tunnel syndrome. Part II: Effectiveness of surgical treatments – a systematic review. Arch Phys Med Rehabil. 2010, 91: 1005–24.
12.
JakabEGanosDCookFW. Transverse carpal ligament reconstruction in surgery for carpal tunnel syndrome: a new technique. J Hand Surg Am. 1991, 16: 202–6.
13.
KanataniTFujiokaHKurosakaMNaguraISumiM. Delayed electrophysiological recovery after carpal tunnel release for advanced carpal tunnel syndrome: a two-year follow-up study. J Clin Neurophysiol. 2013, 30: 95–7.
14.
KapandjiAI. Plastic surgical enlargement of the anterior annular carpal ligament in the treatment of carpal tunnel syndrome. Ann Chir Main Memb Super. 1990, 9: 305–13.
15.
KarlssonMKLindauTHagbergL. Ligament lengthening compared with simple division of the transverse carpal ligament in the open treatment of carpal tunnel syndrome. Scand J Plast Reconstr Surg Hand Surg. 1997, 31: 65–9.
16.
KimJParkMShinS. (2014) What is the minimum clinically important difference in grip strength?Clin Orthop Relat Res. 472: 2536–41.
17.
KronlageSCMenendezM. The benefit of carpal tunnel release in patients with electrophysiologically moderate and severe disease. J Hand Surg Am. 2015, 40: 438–44.
18.
KungJBudoffJEWeiMLGharbaouiILuoZP. The origins of the thenar and hypothenar muscles. J Hand Surg Br. 2005, 30: 475–6.
19.
LeiteJCJerosch-HeroldCSongF. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskeletal Disord. 2006, 7: 78.
20.
LevineDWSimmonsBPKorisMJet al.A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993, 75: 1585–92.
21.
Lluch A. El Síndrome del Túnel Carpiano. Barcelona: Ed. Mitre, 1987: 139–40.
22.
LluchA. Transverse carpal ligament reconstruction for Carpal tunnel syndrome. J Hand Surg Am. 1993, 18: 170–1.
23.
Lluch A. Flexor retinaculum reconstruction after CTS release. Long term review of 248 cases. Abstracts of EUROHAND 2011, combined XVIth FESSH (Federation of the European Societies for Surgery of the Hand) Congress and Xth EFSHT (European Federation of Societies for Hand Therapy) Congress. Oslo, Norway, 26–28 May 2011. J Hand Surg Eur. 2011, 1: S3–147.
24.
LluchAPitagorasT. Flexor retinaculum reconstruction after CTS release: long term review of 145 cases. J Hand Surg Am. 2003, 28: 71–2.
25.
MathiowetzVWeberKVollandGKashmanN. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984, 9: 222–6.
26.
McCormackHMHorneDJSheatherS. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988, 18: 1007–19.
27.
NetscherDT. The benefit of transverse carpal ligament reconstruction following open carpal tunnel release. Plast Reconstr Surg. 2003, 111: 2020–2.
28.
NetscherDTMosharrafaALeeMet al.Transverse carpal ligament: its effect on flexor tendon excursion, morphologic changes of the carpal canal, and on pinch and grip strengths after open carpal tunnel release. Plast Reconstr Surg. 1997, 100: 636–42.
29.
NetscherDTSteadmanAKThornbyJCohenV. Temporal changes in grip and pinch strength after open carpal tunnel release and the effect of ligament reconstruction. J Hand Surg Am. 1998, 23: 48–54.
30.
PeolssonAHedlundRObergB. Intra- and inter-tester reliability and references values for hand strength. J Rehabil Med. 2001, 33: 36–41.
31.
PriceDDMcGrathPARafiiABuckinghamB. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983, 17: 45–56.
32.
RichardsLPalmiter-ThomasP. Grip strength measurement: a critical review of tools, methods and clinical utility. Crit Rev Phys Rehabil Med. 1996, 8: 87–109.
33.
RichmanJAGelbermanRHRydevikBLGylys-MorinVMHajekPCSartorisDJ. Carpal tunnel volume determination by magnetic resonance imaging three-dimensional reconstruction. Hand Surg Am. 1987, 12: 712–7.
34.
RotmanMBEnkvetchakulBVMegerianJTGozaniSN. Time course and predictors on median nerve conduction after carpal tunnel release. J Hand Surg Am. 2004, 29: 367–72.
35.
Scholten R, Mink van der Molen A, Uitdehaag B, Bouter L, de Vet H. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007: CD003905.
36.
TangJBGiddinsG. Why and how to report surgeons level of expertise. J Hand Surg Eur. 2016, 41: 365–6.
37.
TubianaR. Carpal tunnel syndrome: some views on its management. Ann Hand Surg. 1990, 9: 325–30.
XuLHuangFHouCH. Treatment for carpal tunnel syndrome by coronal Z-type lengthening of the transverse carpal ligament. J Pak Med Assoc. 2011, 61: 1068–71.
40.
ZhangXLiYWenSZhuHShaoXYuY. Carpal tunnel release with subneural reconstruction of the transverse carpal ligament compared with isolated open and endoscopic release. Bone Joint J. 2015, 9: 221–8.
