Surgical release in extreme cases of carpal tunnel syndrome

M. Mondelli, L. Padua, F. Reale, R. Padua, I. Aprile, F. Ginanneschi

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Introduction. Surgical release is the most effective therapy for the symptoms of carpal tunnel syndrome (CTS). The best timing for surgery is a matter of debate, however, since in cases of minor severity, symptoms may improve or resolve spontaneously or with medical therapy. It is widely considered, moreover, that surgery may be ineffective in extreme cases (those with atrophy of the thenar eminence muscles), especially if the patient is elderly. Main aim. We report our experience with surgical release, by the mini-incision of the palm technique, in ten extremely severe cases. Methods. The ten hands belonging to ten patients were selected from 209 hands operated consecutively between 1 January 1997 and 31 May 1999 at Neurosurgery 1 of the Siena Hospital. The patients included nine women and one man, mean age 65 years (43-82 years). Before surgery, all were in clinical stage 5 of the severity scale of the Italian CTS Study Group (atrophy of thenar eminence) and in an extreme electrophysiological stage of severity (absence of motor and sensory responses). The protocol consisted of clinical and electrophysiological evaluation, with the patients completing the self-administrered Boston questionnaire (BQ) before the operation and 1 and 6 months after it. Results. After surgical release, all patients reported an absence of pain and the disappearance or reduction of paraesthesia. Six months after the operation, motor and sensory responses returned in eight and five hands, respectively. The BQ showed a significant improvement in symptom and functional scores, although muscle atrophy remained unchanged. No correlation was found between the degree of clinical and electrical improvement and the age of the patients. Conclusion. It is possible to obtain good clinical (particularly with regard to sensory symptoms) and electrophysiological results in extreme cases of CTS, even in elderly patients.

Original languageEnglish
JournalNeurological Sciences
Issue number4 SUPPL.
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


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