The thenar motor branch during carpal tunnel decompression: "the expert opinion".
BACKGROUND
Iatrogenic injury to the thenar motor branch (TMB) of the median nerve is a rare but serious complication of carpal tunnel decompression (CTD). Variability in the anatomical course of the branch is well documented in the literature. We aimed to explore and document "expert experience and attitude" to the TMB during CTD.


METHODS
All members of the British Society for Surgery of the Hand (220) were sent a short postal questionnaire, in which 153 questionnaires (70%) were returned.


RESULTS
The open technique was routinely used by 97% of the surgeons, 70% replied that either very rarely or never formally explored the TMB during CTD and 71% of surgeons saw the TMB lying superficially in less than 5% of cases. Among surgeons, 49 had never encountered an iatrogenic injury while only 14 had seen more than 5 cases in their careers. Finally, 71% of surgeons agreed that formal exploration of the nerve is not necessary during uncomplicated cases.


CONCLUSIONS
The "consensus" view suggests that formal demonstration of the thenar branch of the median nerve during CTD is unnecessary. The incidence of iatrogenic injuries seen was low. A number of useful strategies to avoid iatrogenic injuries are suggested.
Candal-Couto
J J
JJ
Department of Trauma and Orthopaedic Surgery, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumbria NE63 9JJ, UK.
Sher
J L
JL
D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D019299:Decompression, Surgical; D006225:Hand / Q000294:innervation*; D006801:Humans; D007049:Iatrogenic Disease; D008475:Median Nerve / Q000293:injuries*; D011795:Surveys and Questionnaires