Long-term effects of preserving or splitting the carpal ligament in carpal tunnel operation

Abstract

Carpal tunnel syndrome is treated very successfully by surgical release of the flexor retinaculum. However, in some patients, all symptoms are not resolved. Weakness in grip strength and pain in the thenar and hypothenar areas corresponding to the end of the transverse ligament after its complete section have been described as common complications of classical neurolysis of the median nerve. This study presents here the long-term results of decompression operation of the median nerve at the wrist, conserving the transverse ligament, as well as its comparison with the classical open neurolysis with a complete section of the ligament. This is an analysis of a retrospective cohort of 114 patients, who were operated on for carpal tunnel syndrome. A clinical, electromyographic, and dynamometric evaluation of the patients studied was carried out in a comparative analysis of the surgical techniques used (flexor retinaculum lengthening according to the Simonetta technique and classical open neurolysis of the median nerve), in a period of 10 years after the operation. The ligamentoplasty technique, in the long-term, contributes to better results of manual force, with a smaller resolution of tingling sensations than the neurolysis with complete section of the transverse ligament. For those patients who do not present a severe clinical or electromyographic syndrome, and in addition require manual effort for their daily activities, the technique of ligamentoplasty, according to Simonetta, is a surgical option to be taken into account.

The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial

“…A similar prospective study compared endoscopic carpal tunnel decompression with open carpal tunnel decompression and did not find differences between the two techniques in functional and electromyography outcomes, despite a significant shortening in median nerve motor distal latency and an increase in the velocity of sensory conductions in both groups [34]. A retrospective analysis of 114 CTS patients compared two surgical procedures, namely, classical open neurolysis of the median nerve with flexor retinaculum lengthening according to the Simonetta technique, and demonstrated that ligamentoplasty according to the Simonetta technique led to better manual force in 10 years of follow-up [35]. A prospective, randomized, double-blind, controlled trial involving 50 CTS patients compared the longitudinal epineurotomy of the median nerve with the simple dissection of the carpal ligament and found no differences in distal motor latency, distal sensory latency, or grip strength after 180 days of follow-up [36].…”