Jornal Internacional de Medicina Física e Reabilitação
Acesso livre

Abstrato

Effects of Modified Camitz Opponensplasty to Restore Thumb Opposition for Severe Carpal Tunnel Syndrome

Shingo Nobuta, Katsumi Sato and Eiji Itoi

Objective: Hand function damaged by Carpal tunnel syndrome (CTS) is usually recoverable after the surgery of carpal tunnel release, but treatment for severe CTS does not always result in functional recovery. The purpose of the present study was to assess the effectiveness of modified Camitz opponensplasty for severe CTS. Specifically, we employed a combined operation of open carpal tunnel release (OCTR) and modified Camitz opponensplasty for severe CTS patients who needed early recovery of thumb opposition.
Methods: The subjects were 26 hands in 22 patients with severe CTS. Before surgery, all hands had marked thenar muscle atrophy and loss of thumb opposition. All patients underwent surgery through OCTR and modified Camitz opponensplasty using a pulley at the radial side of the released flexor retinaculum. Compound muscle action potential (CMAP) from the abductor pollicis brevis (APB) muscle and the second lumbrical (SL) muscle were recorded and analyzed. Static 2 points discrimination test data, grip strength, pulp pinch strength and active palmar abduction of the thumb were assessed. Outcomes were evaluated according to Kelly’s grading and patient-reported outcome measures were assessed using the Carpal Tunnel Syndrome instrument (CTSI).
Results: Before surgery, APB-CMAP was not recordable and SL-CMAP was recordable in all 26 hands. After surgery, according to Kelly’s grading of outcome, results were excellent in 11 hands, good in 12, and fair in three. In all patients, both the symptom severity score and function score in CTSI markedly improved at final follow-up. At 3 months, postoperative pulp pinch strength and active palmar abduction of the thumb increased significantly. There was no significant difference in postoperative thumb palmar abduction and pulp pinch strength between the hands showing and not showing the recovery of APB-CMAP.
Conclusion: Modified Camitz opponensplasty was effective to restore thumb palmar abduction and pulp pinch strength from the early postoperative phase in severe CTS.