Primary Ring Flexor Digitorum Superficialis Transfer with Open Carpal Tunnel Release in Extreme Carpal Tunnel Syndrome

Young-Seok Lee; Ho-Jun Cheon; Young-Woo Kim; Sang Hyun Woo

doi:10.12790/jkssh.2017.22.1.34

Journal List > J Korean Soc Surg Hand > v.22(1) > 1106576

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Lee, Cheon, Kim, and Woo: Primary Ring Flexor Digitorum Superficialis Transfer with Open Carpal Tunnel Release in Extreme Carpal Tunnel Syndrome

Original Article

Journal of the Korean Society for Surgery of the Hand 2017; 22(1): 34-40.

Published online: 30 March 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.1.34

Primary Ring Flexor Digitorum Superficialis Transfer with Open Carpal Tunnel Release in Extreme Carpal Tunnel Syndrome

Young-Seok Lee, Ho-Jun Cheon, Young-Woo Kim, Sang Hyun Woo

W Institute for Hand and Reconstructive Microsurgery, W Hospital, Daegu, Korea.

Correspondence to: Sang Hyun Woo. W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea. TEL: +82-53-550-5000, FAX: +82-53-552-4000, handwoo@hotmail.com

Received 1 November 2016 Revised 18 January 2017 Accepted 27 January 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical outcome for primary ring flexor digitorum superficialis transfer with open carpal tunnel release in extreme carpal tunnel syndrome.

Methods

Ring flexor digitorum superficialis transfer with open release of the transverse carpal ligament was performed on 23 patients who were diagnosed with extreme carpal tunnel syndrome between September 2008 and August 2013. All patients had visibly severe atrophies, with no sign of compound muscle action potential (CMAP) of abductor pollicis brevis from electromyography. They wanted simultaneous reconstruction of the function of the hand as well as recovery of the numbness. We evaluated the clinical results using key-pinch, hand grip abilities, disability of the arm, shoulder and hand (DASH) scores, Kapandji scores.

Results

Key-pinch and hand grip abilities had no significant difference after the surgery compared with before, but DASH scores were significantly different, averaging 18.6 after, compared with 39.8 before surgery. And Kapandji scores increased significantly from 4.8 before, to 9.3 after the surgery. Numbness and pain in hands were also markedly improved with a different score on VAS each.

Conclusion

Primary ring flexor digitorum superficialis opponensplasty with open carpal tunnel release is a very practical and useful way of treating extreme carpal tunnel syndrome in thenar weakness.

Keywords: Carpal tunnel syndrome, Tendon transfer, Flexor tendon

Figures and Tables

Fig. 1

(A) Preoperative design of carpal tunnel release with primary opponensplasty with 4th flexor digitorum superficialis (FDS) tendon via sling of flexor carpi ulnaris tendon (FCU). (B) The 4th FDS tendon was harvested from the proximal phalangeal crease and FCU sling was made on the ulnar aspect of the distal wrist. (C) After fixation of the FCU, the 4th FDS tendon was transferred subcutaneously to the radial side of 1st metacarpophalangeal joint. (D) Immediate postoperative view. (E) Preoperative view of severe thenar atrophy with weak opposition. (F) Postoperative view, 8 months later. (G) Postoperative view, 18 months later, opposition is restored but abductor pollicis bresvis is not restored.

Table 1

Clinical results of primary flexor superficialis transfer with open carpal tunnel release

Values are presented as mean±standard deviation.

DASH, disability of the arm, shoulder and hand; VAS, visual analog scale.

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