title: Long-term effects of preserving or splitting the carpal ligament in carpal tunnel operation.
abstract: Carpal tunnel syndrome is treated very successfully by surgical release of the flexor retinaculum. However, in some patients, all symptoms are not resolved. Weakness in grip strength and pain in the thenar and hypothenar areas corresponding to the end of the transverse ligament after its complete section have been described as common complications of classical neurolysis of the median nerve. This study presents here the long-term results of decompression operation of the median nerve at the wrist, conserving the transverse ligament, as well as its comparison with the classical open neurolysis with a complete section of the ligament. This is an analysis of a retrospective cohort of 114 patients, who were operated on for carpal tunnel syndrome. A clinical, electromyographic, and dynamometric evaluation of the patients studied was carried out in a comparative analysis of the surgical techniques used (flexor retinaculum lengthening according to the Simonetta technique and classical open neurolysis of the median nerve), in a period of 10 years after the operation. The ligamentoplasty technique, in the long-term, contributes to better results of manual force, with a smaller resolution of tingling sensations than the neurolysis with complete section of the transverse ligament. For those patients who do not present a severe clinical or electromyographic syndrome, and in addition require manual effort for their daily activities, the technique of ligamentoplasty, according to Simonetta, is a surgical option to be taken into account.
authors.affiliation: Orthopaedics Department, Hospital of Ávila-Sacyl, Ávila, Spain. ofmartin@msn.com
authors.forename: Omar
authors.initials: O
authors.lastname: Faour-Martín
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Martín-Ferrero
authors.forename: Aurelio
authors.initials: A
authors.lastname: Vega Castrillo
authors.forename: Ana
authors.initials: A
authors.lastname: Almaraz-Gómez
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Valverde-García
authors.forename: Luis
authors.initials: L
authors.lastname: Amigo Liñares
authors.forename: María Ángeles de la
authors.initials: MÁ
authors.lastname: Red-Gallego
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery