Minimally invasive modified Camitz opponensplasty for severe carpal tunnel syndrome

Abstract

Purpose: We aimed to compare the clinical results and the complications between the minimally invasive modified Camitz opponensplasty and the conventional Camitz opponensplasty for severe carpal tunnel syndrome (CTS), and to evaluate the efficacy of the modified technique for CTS. Methods: Twenty-eight hands in 24 patients with severe CTS who had disorder of the thumb opposition with thenar muscle atrophy (group 1) were treated by minimally invasive modified Camitz opponensplasty, passing the transferred palmaris longus (PL) tendon under the abductor pollicis brevis (APB) fascia using only palm and thumb incision, and no incision to either wrist crease or forearm. Ten hands in 10 patients (group 2) were treated by the conventional Camitz opponensplasty. Clinical evaluation was made by comparing the results before and after surgery for the angle of the thumb palmar abduction, pinch power, and grip strength. Results: All clinical findings significantly improved after surgery compared with before surgery in all patients. In group 1, there were no complications including transferred tendon bowstring, painful wrist scar, or injury to the palmar cutaneous branch of the median nerve in all hands. Conversely, patients in group 2 had four painful wrist scars and nine bowstrings of the transferred tendon. Conclusions: Several complications have been considered to attribute to the long incision and an extensive dissection crossing the wrist crease from the palm to the wrist in the conventional Camitz procedure. The current modified Camitz opponensplasty by minimally invasive incision without straddling the wrist crease is a simple and effective procedure that can decrease the risk of painful scar around the wrist crease in severe CTS patients with disorder of thumb opposition. Additionally, this technique, by passing the transferred PL tendon under the APB fascia, is useful in restoring the thumb opposition immediately, and in preventing the bowstringing of the transferred tendon.

Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function

“…In our study, such atrophy was observed in 49% of patients with CCTS before surgery. However, studies on CCTS have clearly shown that atrophy of the APB muscle in particular is very common [ 33 , 34 ]. Moreover, because of this, many patients lose the ability to oppose their thumb, an activity which is essential for daily functioning.…”

“…This improvement was statistically significant in women; however, no such improvement was observed in the male group. Studies on the electrophysiological measurements of the APB have also indicated improved parameters after surgery [ 34 ]. Capasso’s work on severe CTS demonstrated that the strength of the hand improved after surgery [ 34 ].…”

“…Studies on the electrophysiological measurements of the APB have also indicated improved parameters after surgery [ 34 ]. Capasso’s work on severe CTS demonstrated that the strength of the hand improved after surgery [ 34 ]. With a significant improvement in strength in the hand, post-operative patients can perform more activities not possible before surgery, which certainly affects their satisfaction with the operation.…”

Novel Surgical Procedure for Half Palmaris Longus Transfer during Opponensplasty of the Thumb for Patients with Carpal Tunnel Syndrome: A Technical Note

“…However, conventional Camitz opponensplasty has several disadvantages. Firstly, the extended incision in the palm and wrist involves extensive soft tissue dissection, which increases the risk of iatrogenic injury to the palmar cutaneous branch of the median nerve 2,7,8 and can cause painful scarring of the wrist 5,9 . Prominent bowstringing of the transferred tendon is one of the main shortcomings 4,8 .…”