CARPAL-TUNNEL SYNDROME IN PATIENTS WITH R HEUMATOID-ARTHRITIS - LONG-TERM FOLLOW-UP-STUDY

Between July 1974 and December 1989, carpal tunnel-syndromes (CTS) wer e operated on in 903 hands of 746 patients. 147 of these patients (191 hands) were suffering from chronic inflammatory joint diseases. In 11 patients CTS was the first sign of rheumatoid arthritis (R.A.). The h ands showed intraoperatively in 44.8% (n = 86/191) an extensive tenosy novitis with an aggressive infiltration. In 19% (n = 36/191), we had t o extend the obligate tenosynovectomy on the flexor tendon parts of th e fingers and ligaments (28 hands). 21 articulosynovectomies on the wr ist or finger joints were performed. In 6 hands (8.0%) tendon ruptures were repaired. A questionaire was completed for 107 of 147 patients ( 72.8%) (with 145 operated hands). Clinical (77 hands) and electromyogr aphical examinations (49 hands) were performed an average of 5.1 (0.7 - 15) years postoperatively. 20 patients (13.6%) died, 20 could not be traced. In 86% (n = 125/145) of the patients we achieved relief of pa in and a marked reduction of neurological deficits. 96.3% of the patie nts were content. The improvement of function of the hand after surgic al intervention is of a great benefit for the patient with R.A. The ov erall risks of the procedure are low (complications 14%; no recidivism ). Therefore, we recommend surgery in early stages after a confirmed d iagnosis or a reasonable suspicion.