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Flexor Tenosynovectomy For Carpal Tunnel Syndrome Confers No Extra Benefit
A DGReview of :"The Role of Flexor Tenosynovectomy in the Operative Treatment of Carpal Tunnel Syndrome"
Journal of Bone and Joint Surgery. American Volume
03/04/2002
By David Loshak
Routine flexor tenosynovectomy as an adjunct to open carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome has no greater benefit than sectioning of the transverse carpal ligament.
Specialists at New York Presbyterian Hospital, Columbia-Presbyterian Medical Center, New York, United States, could not find any clinical correlations that might predict who would benefit from flexor tenosynovectomy on the basis of either the gross (intraoperative) or the histological evaluation of the flexor tenosynovium.
The specialists carried out a prospective study in which they randomised 88 wrists in 87 patients (f=72, m=15, mean age 58 years) with idiopathic carpal tunnel syndrome to open carpal tunnel release with or without flexor tenosynovectomy.
A validated self-administered questionnaire to assess symptom severity and functional status was completed both before and after the operation. All patients were followed for at least 12 months after their surgery.
Intraoperatively, the tenosynoviums of all patients were graded on the basis of gross appearance. Half of the wrists were then treated with a flexor tenosynovectomy through the operative incision. The tenosynoviums were graded histologically.
The specialists then looked for three sets of correlations - between gross appearance of the tenosynoviums and symptoms and functional status both before and after surgery, between the histological appearance of the tenosynoviums and symptoms and functional status, also both before and after surgery, and between the gross and the histological findings. But the specialists found no significance between the groups in any of these correlations.
After the operation, symptom severity and functional status (paired t test) improved significantly in both groups but, again, there was no significant difference between them (unpaired t test).
Journal of Bone and Joint Surgery (American) 2002; 84:221-225.
"The Role of Flexor Tenosynovectomy in the Operative Treatment of Carpal Tunnel Syndrome"
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