title: Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?
abstract: BACKGROUND
  The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome.
  
  
  METHODS
  In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel's signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed.
  
  
  RESULTS
  The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly.
  
  
  CONCLUSIONS
  We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.
authors.affiliation: Diyarbakir Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey.
authors.forename: Serda
authors.initials: S
authors.lastname: Duman
authors.affiliation: Baltalimani Bone and Joint Diseases Hospital, 34470 Istanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Sahin
authors.affiliation: Faculty of Medicine, Erzincan University, 24030 Erzincan, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Sofu
authors.affiliation: Faculty of Medicine, Erzincan University, 24030 Erzincan, Turkey.
authors.forename: Yalkin
authors.initials: Y
authors.lastname: Camurcu
authors.affiliation: Elbistan State Hospital, 46300 Kahramanmaras, Turkey.
authors.forename: Hanifi
authors.initials: H
authors.lastname: Ucpunar