J Korean Soc Surg Hand.  2017 Mar;22(1):34-40. 10.12790/jkssh.2017.22.1.34.

Primary Ring Flexor Digitorum Superficialis Transfer with Open Carpal Tunnel Release in Extreme Carpal Tunnel Syndrome

• Lee YS
• Cheon HJ
• Kim YW
• Woo SH

• KMID: 2375465
• DOI: http://doi.org/10.12790/jkssh.2017.22.1.34

Abstract

PURPOSE
To analyze the clinical outcome for primary ring flexor digitorum superficialis transfer with open carpal tunnel release in extreme carpal tunnel syndrome.
METHODS
Ring flexor digitorum superficialis transfer with open release of the transverse carpal ligament was performed on 23 patients who were diagnosed with extreme carpal tunnel syndrome between September 2008 and August 2013. All patients had visibly severe atrophies, with no sign of compound muscle action potential (CMAP) of abductor pollicis brevis from electromyography. They wanted simultaneous reconstruction of the function of the hand as well as recovery of the numbness. We evaluated the clinical results using key-pinch, hand grip abilities, disability of the arm, shoulder and hand (DASH) scores, Kapandji scores.
RESULTS
Key-pinch and hand grip abilities had no significant difference after the surgery compared with before, but DASH scores were significantly different, averaging 18.6 after, compared with 39.8 before surgery. And Kapandji scores increased significantly from 4.8 before, to 9.3 after the surgery. Numbness and pain in hands were also markedly improved with a different score on VAS each.
CONCLUSION
Primary ring flexor digitorum superficialis opponensplasty with open carpal tunnel release is a very practical and useful way of treating extreme carpal tunnel syndrome in thenar weakness.

Keyword

Carpal tunnel syndrome; Tendon transfer; Flexor tendon

MeSH Terms

Action Potentials
Arm
Atrophy
Carpal Tunnel Syndrome*
Electromyography
Hand
Hand Strength
Humans
Hypesthesia
Ligaments
Shoulder
Tendon Transfer

Figure

• 

  Fig. 1 (A) Preoperative design of carpal tunnel release with primary opponensplasty with 4th flexor digitorum superficialis (FDS) tendon via sling of flexor carpi ulnaris tendon (FCU). (B) The 4th FDS tendon was harvested from the proximal phalangeal crease and FCU sling was made on the ulnar aspect of the distal wrist. (C) After fixation of the FCU, the 4th FDS tendon was transferred subcutaneously to the radial side of 1st metacarpophalangeal joint. (D) Immediate postoperative view. (E) Preoperative view of severe thenar atrophy with weak opposition. (F) Postoperative view, 8 months later. (G) Postoperative view, 18 months later, opposition is restored but abductor pollicis bresvis is not restored.

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