Clinical and neurophysiological outcome of surgery in extreme carpal tunnel syndrome.

INTRODUCTION

Surgical release is the most effective therapy for the symptoms of carpal tunnel syndrome (CTS). It is widely considered that surgery may be ineffective in 'extreme' cases (those with atrophy of the thenar eminence muscles and no sensory and motor response of the median nerve).

OBJECTIVE

To report clinical and electrophysiological outcome of 10 subjects with 'extreme' CTS surgically treated.

METHODS

Ten hands belonging to 10 patients (9 women and one man, mean age 65 years) underwent surgical release by the mini-incision of the palm technique. All showed atrophy of thenar eminence and absence of motor and sensory responses of the median nerve. The protocol consisted of clinical and electrophysiological evaluation, with the patient completing the self-administered Boston questionnaire (BQ) before the operation and one and 6 months after it.

RESULTS

After surgical release, all patients reported an absence of pain and disappearance or reduction of paraesthesia. Six months after the operation, motor and sensory responses of the median nerve returned in 8 and 5 hands, respectively. The BQ showed a significant improvement in symptom and functional scores, although muscle atrophy remained unchanged. No correlation was found between the degree of clinical and electrical improvement and the age of the patients.

CONCLUSION

It is possible to obtain good clinical and electrophysiological results even in extreme cases of CTS.