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The Journal of Bone and Joint Surgery (American) 84:221-225 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

The Role of Flexor Tenosynovectomy in the Operative Treatment of Carpal Tunnel Syndrome

Charlotte Shum, MD, May Parisien, MD, Robert J. Strauch, MD and Melvin P. Rosenwasser, MD

Investigation performed at New York Presbyterian Hospital, Columbia-Presbyterian Medical Center, New York, NY

Charlotte Shum, MD
Department of Orthopaedic Surgery, New York Presbyterian Hospital, Columbia-Presbyterian Medical Center, 622 West 168th Street, PH-11-1129, New York, NY 10032-3784

May Parisien, MD
Department of Pathology, New York Presbyterian Hospital, Columbia-Presbyterian Medical Center, 622 West 168th Street, PH-15W-1575, New York, NY 10032-3784

Robert J. Strauch, MD
Department of Orthopaedic Surgery, New York Presbyterian Hospital, Columbia-Presbyterian Medical Center, 622 West 168th Street, PH-11-1115, New York, NY 10032-3784

Melvin P. Rosenwasser, MD
Department of Orthopaedic Surgery, New York Presbyterian Hospital, Columbia-Presbyterian Medical Center, 622 West 168th Street, PH-11-1119, New York, NY 10032-3784

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: We conducted a prospective, randomized study to evaluate the effect of flexor tenosynovectomy as an adjunct to open carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome and reviewed the histological characteristics of the flexor tenosynovium to identify possible correlations between histopathology and symptoms.

Methods: Eighty-eight wrists in eighty-seven patients with idiopathic carpal tunnel syndrome were randomized to open carpal tunnel release with or without flexor tenosynovectomy. A validated self-administered questionnaire for the assessment of symptom severity and functional status was completed both before and after the operation to assess patient outcome. The study group included fifteen men and seventy-two women with a mean age of fifty-eight years. All patients were followed for a minimum of twelve months after the operation. Intraoperatively, the tenosynovium of all patients was graded on the basis of its gross appearance. Half of the wrists were then treated with a flexor tenosynovectomy through the operative incision, and the tenosynovium was graded histologically. Correlations were sought between the gross appearance of the tenosynovium and the preoperative and postoperative symptoms and functional status, between the histologic appearance of the tenosynovium and the preoperative and postoperative symptoms and functional status, and between the gross and the histologic findings.

Results: After the operation, both groups improved significantly with respect to symptom severity and functional status (paired t test), with no significant difference between the groups (unpaired t test). No significant correlation was found between the gross appearance of the tenosynovium and the preoperative or postoperative symptoms and functional status, between the histologic appearance of the tenosynovium and the preoperative or postoperative symptoms and functional status, or between the gross and the histologic findings.

Conclusions: We observed neither an added benefit nor an increased rate of morbidity in association with the performance of a flexor tenosynovectomy at the time of carpal tunnel release. We identified no clinical correlations that might predict which individuals would benefit from flexor tenosynovectomy on the basis of either the gross (intraoperative) or histologic evaluation of the flexor tenosynovium. Our findings suggest that routine flexor tenosynovectomy offers no benefit compared with sectioning of the transverse carpal ligament alone for the treatment of idiopathic carpal tunnel syndrome.


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An Experiential Rebuttal
Robert M. Lumsden, II, M.D., F.A.C.S.
JBJS Online, 25 Apr 2002 [Full text]