Unveiling the Shroud around Carpal Tunnel SurgeryCarpal tunnel syndrome (CTS) is a fairly well-known condition. The carpal tunnel is a passage in the wrist formed by the wrist (carpal) bones and a band of ligament across the front called the retinaculum. The median nerve and tendons that flex or bend the wrist and thumb go through this tunnel. Anything that puts pressure on the nerve can cause the pain, numbness, and tingling of CTS.
Most cases of CTS can be treated with good results. Thank goodness, because treatment back in the 1800s was amputation! Today, doctors are trying to decide which surgery works best and how much treatment is really necessary. Sometimes CTS requires a two-step method of surgery. The surgeon opens the skin over the wrist and cuts the retinaculum that goes over the median nerve. Then the lining around the tendons is removed. This process is called tenosynovectomy.
But what if both steps aren't really needed? Doctors noticed that when the lining or sheath around the tendons was removed and inspected. Although it looked thick, it was otherwise perfectly normal. There was no inflammation of the tendon sheath causing CTS.
A study was done to see if it's possible to tell which patients need to have the tendon sheath removed. Eighty-eight patients were examined before surgery and followed for at least a year afterward. These patients were compared to patients who only had surgery to remove the ligament across the nerve. This second group of patients did not have the tendon sheath removed.
In both groups, symptoms and function improved equally after surgery. There seemed to be no link between the symptoms present and the condition of the tendon sheath.
Until now, most researchers thought CTS was caused by thickening and inflammation of the tendons in the carpal tunnel area. This study shows that increasing the space in the carpal tunnel by removing the tendon sheath does not change the patient's symptoms. As a result, surgeons at that research hospital are no longer routinely removing the tendon sheath during carpal tunnel surgery.
Charlotte Shum, MD, et al. The Role of Flexor Tenosynovectomy in the Operative Treatment of Carpal Tunnel Syndrome. In The Journal of Bone and Joint Surgery. February 2002. Vol. 84-A. No. 2. Pp. 221-225.
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