Results of a differentiated approach to open decompression of the median nerve in carpal tunnel syndrome

Introduction Open decompression of the median nerve is a common surgery performed for carpal tunnel syndrome (CTS). Transection of the transverse carpal ligament (TCL) results in impaired hand biomechanics and decreased grip strength when specific anatomy necessitate transection of the thenar muscles along with the ligament.

The objective was to compare short-term and long-term surgical results of CTS patients treated with open decompression in three different settings: without thenar muscle reconstruction, with thenar muscle reattachment and with reconstruction of the thenar muscles.

Material and methods A total of 80 patients with idiopathic CTS treated with 92 surgical procedures were included in the study. They were divided into three groups. The first group included 38 patients (39 surgeries) treated with open decompression without reconstruction of the TCL. Forty surgical procedures were produced for 31 patients of the second group including dissection and reattachment of the thenar muscles located at the site of the median nerve dissection. Median nerve decompression followed by TCL reconstruction were performed for 11 patients of the third group treated with 13 surgical procedures.

Results All patients demonstrated positive dynamics with more significant recovery of the hand function achieved after open decompression of the median nerve and reattachment of the thenar muscles and reconstruction of the spinal nerve with the outcome improved at three months and stabilized at six months of the surgery.

Discussion A differentiated approach to treatment ensured the amplitude of the M-response of the brevis muscle abducting the pollicis increased by 15.9 % in the first group, by 34.3 % in the second group, and by 30.5 % in the third group; the impulse velocity along the motor fibers of the median nerve increased by 6.6 %, 13.2 %, and 10.9 %, respectively, at six months. Less improvement in electrophysiological parameters in patients of the first group could be associated with a more advanced surgical technique employed for the patients of the second and third groups.

Conclusion A comparative analysis of the short-term and long-term surgical outcomes of CTS patients revealed clinically significant improvement with both options. However, the hand function recovery was more accomplished in the second and third groups with use of the two methods we developed. 

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