We report a new surgical technique of open carpal
tunnel release with subneural reconstruction of the transverse carpal
ligament and compare this with isolated open and endoscopic carpal
tunnel release. Between December 2007 and October 2011, 213 patients with carpal
tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to
67) were recruited from three different centres and were randomly
allocated to three groups: group A, open carpal tunnel release with
subneural reconstruction of the transverse carpal ligament (n =
68); group B, isolated open carpal tunnel release (n = 92); and
group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no
significant difference between the groups in terms of severity of
symptoms or lateral grip strength. Compared with groups B and C,
group A had significantly better functional status, cylindrical
grip strength and pinch grip strength. There were significant differences
in Michigan Hand Outcome scores between groups A and B, A and C,
and B and C. Group A had the best functional status, cylindrical
grip strength, pinch grip strength and Michigan Hand Outcome score. Subneural reconstruction of the transverse carpal ligament during
carpal tunnel decompression maximises hand strength by stabilising
the transverse carpal arch. Cite this article:
There is conflicting evidence about the functional
outcome and rate of satisfaction of super-elderly patients (≥ 80 years
of age) after carpal tunnel decompression. We compiled outcome data for 756 patients who underwent a carpal
tunnel decompression over an eight-year study period, 97 of whom
were super-elderly, and 659 patients who formed a younger control
group (<
80 years old). There was no significant difference between
the super-elderly patients and the younger control group in terms
of functional outcome according to the mean (0 to 100) QuickDASH
score (adjusted mean difference at one year 1.8; 95% confidence
interval (CI) -3.4 to 7.0) and satisfaction rate (odds ratio (OR)
0.78; 95% CI 0.34 to 1.58). Super-elderly patients were, however,
more likely to have thenar muscle atrophy at presentation (OR 9.2,
95% CI 5.8 to 14.6). When nerve conduction studies were obtained,
super-elderly patients were more likely to have a severe conduction deficit
(OR 12.4, 95% CI 3.0 to 51.3). Super-elderly patients report functional outcome and satisfaction
rates equal to those of their younger counterparts. They are more
likely to have thenar muscle atrophy and a severe nerve conduction
deficit at presentation, and may therefore warrant earlier decompression. Cite this article:
