Carpal tunnel syndrome (CTS) with severe sensory deficit was treated with endoscopic carpal tunnel release in 18 hands of 16 consecutive patients (median age 72 (28-92) years). In all hands, preoperative 2-point discrimination (2-PD) exceeded 15 mm in the radial and ulnar sides of the pulps of at least 2 of the 3 radial digits. All patients underwent an independent evaluation and answered a questionnaire concerning 11 activities of daily living (ADL) preoperatively and 6 months postoperatively. Complete resolution or improvement in daytime numbness and tingling was reported in 12 of 17 hands, of night symptoms in 12 of 16 hands, and of pain in 10 of 11 hands. The median ADL score improved from 3.1 to 1.4 (on a 1-to 5-point scale). 13 of the 16 patients were satisfied with the outcome. Two-PD had normalized in 14 hands and improved in 2. The results indicate that endoscopic carpal tunnel release is effective in improving symptoms and function in patients with CTS and severe sensory deficit, and that the prognosis for sensory recovery is good. n Carpal tunnel syndrome (CTS) can cause severe sensory loss and surgical treatment is generally recommended in these cases (Dawson et al. 1990). Although endoscopic division of the transverse carpal ligament has been shown to be an effective treatment (Chow 1989, Brown et al. 1993, most previous studies involved patient populations with a wide spectrum of disease severity in terms of sensory deficit. No studies have prospectively investigated the outcome in patients with severe preoperative sensory loss. We evaluated prospectively the results of endoscopic carpal tunnel release in a consecutive cohort of 16 patients with CTS and severe sensory deficit. Patients and methodsDuring a 3-year period (1992-1994) 16 consecutive patients (18 hands) with CTS and severe sensory deficit were prospectively studied. The inclusion criteria were CTS, diagnosed on the basis of the presence of daytime (activity-related or continuous) and/or nighttime numbness or tingling in the median nerve distribution in the hand, and 2-point discrimination (2-PD) exceeding 15 mm in the radial and ulnar sides of the pulps of at least 2 of the 3 radial digits. Patients with diabetes, rheumatoid disease, or previous carpal tunnel surgery in the symptomatic hand were excluded. Nerve conduction testing of the median nerve (Atroshi et al. 1996) showed pathologic distal motor latency ( 4.5 ms) and/or pathologic distal sensory latency ( 3.6 ms) in 15 hands. In the remaining 3 hands, only distal motor latency was measured, and this was normal.There were 13 women with a median age of 72 (28-92) years and 3 men aged 49, 81 and 82 years, respectively. The dominant hand was involved in 10 patients. Preoperative symptoms included daytime numbness and/or tingling in 17 hands (15 with continuous numbness), nighttime paresthesias in 16, and pain in 11. The median duration of symptoms was 36 (6-240) months. A positive Tinel sign was recorded in 16 hands and a positive Phalen test in 16. Two-PD exceeding 15 mm was found in ...
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