The Journal of Bone and Joint Surgery, Vol 67, Issue 2 253-256, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Results of internal neurolysis of the median nerve for severe carpal-tunnel syndrome
CE Rhoades, CA Mowery and RH Gelberman
Thirty-six hands in thirty-two patients had internal neurolysis of the
median nerve and carpal tunnel release for severe carpal-tunnel syndrome.
Median-nerve function was evaluated in all hands using Weber two-point
discrimination and electromyography. Thenar-muscle strength or bulk, or
both, were recorded in thirty hands. Ten hands also had Semmes-Weinstein
monofilament pressure-testing. The indication for neurolysis in these
selected patients was the presence of any one of the following: an increase
in two-point-discrimination values, thenar-muscle atrophy, or denervation
potentials in the thenar muscles. Twenty-two (76 per cent) of the
twenty-nine hands that had had diminished two-point discrimination
preoperatively regained normal sensibility. Seven (70 per cent) of ten
hands that had had thenar-muscle weakness (grade 3 or less) preoperatively
regained grade-4 or 5 strength. Nine (50 per cent) of eighteen hands that
had had thenar-muscle atrophy regained normal muscle bulk. Seventy-six per
cent of the patients in this series recovered sensation and 70 per cent
recovered muscle strength, and the procedure was well tolerated. Although
no studies comparing the results of treatment of severe carpal-tunnel
syndrome with and without internal neurolysis have been reported, we think
that neurolysis, if it is done by a surgeon who is skilled in microsurgery,
is a safe and effective procedure for severe carpal-tunnel syndrome.
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