Clinical and neurophysiological outcome of surgery in extreme carpal tunnel syndrome

Introduction: Surgical release is the most effective therapy for the sympto ms of carpal tunnel syndrome (CTS). It is widely considered that surgery ma y be ineffective in 'extreme' cases (those with atrophy of the thenar emine nce muscles and no sensory and motor response of the median nerve). Objective: To report clinical and eletrophysiological outcome of 10 subject s with 'extreme' CTS surgically treated. Methods: Ton hands belonging to 10 patients (9 women and one man, mean age 65 years) underwent surgical release by the mini-incision of the palm techn ique. All showed atrophy of thenar eminence and absence of motor and sensor y responses of the median nerve. The protocol consisted of clinical and ele ctrophysiological evaluation, with the patient completing the self-administ ered Boston questionnaire (BQ) before the operation and one and lj months a fter it. Results: After surgical release, all patients reported an absence of pain a nd disappearance or reduction of paraesthesia. Six months after the operati on, motor and sensory responses of the median nerve returned in X and 5 han ds, respectively. The BQ showed a significant improvement in symptom and fu nctional scores, although muscle atrophy remained unchanged. No correlation was found between the degree of clinical and electrical improvement and th e age of the patients. Conclusion: It is possible to obtain good clinical and electrophysiological results even in extreme cases of CTS. 6 2001 Elsevier Science Ireland Ltd. All rights reserved.