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Electrophysiological Study And Thumb Function Outcome Of Patients With Severe Carpal Tunnel Syndrome Who Had Modified Camitz Tendon Transfer And Open Carpal Tunnel Release
Wing-Yuk Ip, MD; Claire Marie Durban, MD; Bernard Antolin, MD; Leonard li, MD
United Christian Hospital, Hong Kong, Hong Kong

Opposition is the most important motion of the hand and it requires a congruent saddle-shaped carpometacarpal joint (CMCJ), thenar muscles, and the median nerve to innervate these thenar muscles. In chronic, severe carpal tunnel syndrome (CTS), two of these components may be lost as the result of the median nerve injury. The modified Camitz opponensplasty which employs a pulley at the level of the carpal tunnel to direct the pull of the PL in line with the APB restores thumb palmar abduction and has the advantage being able to perform an open carpal tunnel release at the same time of the opponensplasty. This study was to assess the recovery and level of activity of the APB, as well as the activity of the PL muscle during thumb opposition and abduction after performing the modified Camitz opponensplasty. A total of 21 patients were identified and included in the study.

RESULTS
Pre-operatively, all patients complained of hand weakness or clumsiness in handling objects, or both.Improvement of numbness and paresthesia were noted in 19 (90%) of patients, with 2 (9.5%) having full resolution of symptoms. Twenty (95.2%) patients were able to reach 80% of the abduction height of the contralateral hand. Good outcomes were attained in 13 (61.9%) patients. There was significant improvement in the mean grip strength (P=0.000) and tripod pinch grip strength (p=0.000). Seven (33.3%) patients did not have any signs of APB recovery after the procedure, while 6 (28.6%) had full recovery. For palmaris longus activities, on thumb opposition, 12 (57.1%) patients had an abundant muscle contraction, 7 (33.3%) had moderate while 2 (9.5%) had sparse activity. During thumb abduction, it was noted that 11 (52.4%) had abundant activity, 6 (28.6%) had moderate activity, 3 (14.3%) had sparse and 1 (4.8%) had no activity.

CONCLUSION
We conclude that the Camitz opponensplasty is a viable option for patients with severe carpal tunnel syndrome and severe thenar muscle atrophy. While results of open release alone is promising, there is difficulty in pinpointing which patient is likely to recover, and which one will not. Also, it is beneficial to the patient during the early post-operative rehabilitation period when the APB and opponens muscles have not recuperated yet. It is a good adjunct to improving hand function during this time.


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