title: Is epineurectomy necessary in the surgical management of carpal tunnel syndrome?
abstract: BACKGROUND
  In this study, it was aimed to determine whether median nerve epineurectomy is beneficial in the surgical management of carpal tunnel syndrome (CTS).
  
  
  METHODS
  The study enrolled 72 patients including 34 patients without epineurectomy (Group A) and 38 patients with epineurectomy (Group B). Surgery was performed in patients with severe electrodiagnostic CTS findings, CTS duration >1 year and flattening along with hypervascularization in median nerve. All patients were assessed by visual analog scale, two-point discrimination test as well as subjective and objective findings at baseline and on the months 1, 3, and 6 after surgery.
  
  
  RESULTS
  The mean age was 58.3 years (42-75 years) in 38 patients who underwent an epineurectomy, whereas it was 61.5 years (41-82 years) in 34 patients who did not have an epineurectomy. The groups were similar with regard to age, gender, duration of symptoms, and preoperative physical findings. Mean visual analog scale (VAS) scores were 1.7 in Group A and 1.8 in Group B. Again, these differences were not significant, on physical examination, the average two-point discrimination in the distribution of the median nerve was 4.9 mm (range: 3-11 mm) in Group A and 5.3 mm (range: 3-10 mm) in Group B. In postoperative evaluations, there was a better improvement in visual analog scale scores, two-point discrimination test and subjective symptoms including dysesthesia, pain and nocturnal pain within first 3 months; however, there was no marked difference in objective and subjective findings on the 6th month. No complication or recurrence was observed.
  
  
  CONCLUSIONS
  We believe that median nerve epineurectomy is unnecessary in the surgical management of primary CTS since it has no influence on the midterm outcomes.
authors.affiliation: Department of Orthopaedics and Traumatology, Kırıkkale University Medical Faculty, Yahsihan 71100, Kırıkkale, Turkey.
authors.forename: U
authors.initials: U
authors.lastname: Tiftikci
authors.affiliation: Department of Orthopaedics and Traumatology, Kırıkkale University Medical Faculty, Yahsihan 71100, Kırıkkale, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Serbest
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004568:Electrodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000601:surgery*; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016896:Treatment Outcome