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Basal Joint Arthroplasty Decreases Carpal Tunnel Pressure
Kevin Lutsky, MD; Asif Ilyas, MD; Nayoung Kim, BS; Pedro Beredjiklian, MD
Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Background: There is a documented association between carpal tunnel syndrome (CTS) and thumb carpometacarpal (CMC) arthritis, and these conditions commonly coexist. We have observed that patients with who have previously undergone thumb basal joint arthroplasty (BJA) rarely develop CTS in the future. Our hypothesis is that the baseline pressure within the carpal tunnel in patients with CMC arthritis is higher than the general population, and that BJA decreases the pressure within the carpal tunnel.

Methods and Materials: Fifteen patients (3 with co-existent CTS) undergoing BJA were enrolled in the study. The pressure within the carpal tunnel immediately before and after BJA was measured using a commercially available pressure monitor device (Stryker STIC, Kalamazoo, MI). In patients with concomitant CTS undergoing both BJA and carpal tunnel release (CTR), the pressure was measured after BJA but prior to release of the transverse carpal ligament.

Results: The pressure within the carpal tunnel decreased in all patients. The mean pressure prior to BJA was 18.7 mmHg and decreased to 7.7 mmHg after BJA (p < .05). Patients with concomitant CTS had a mean pre-BJA pressure of 26.7 mmHg, which decreased to 6.0 mmHg after BJA (p < .05).

Conclusion: Patients with thumb CMC arthritis have a high baseline carpal tunnel pressure, which may in part explain the association between these conditions. BJA decompresses the carpal tunnel and decreases the pressure within. In patients with concomitant CTS, BJA alone decreases the carpal tunnel pressure. Further study is warranted on the need for discrete release of the transverse carpal ligament in patients undergoing BJA who have concomitant CTS.

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