A Comparison of Hand Pain and Hand Function after Z-plasty Reconstruction of the Transverse Carpal Ligament with Traditional Median Neurolysis in Carpal Tunnel Syndrome

       Background: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome.   Methods: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and ۵ patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a ۱۲-week period.   Results: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=۰.۲۱۳). But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week ۱, week ۳, and week ۶ after surgery (P<۰.۰۰۱). However, at week ۱۲, no patient complained of hand pain in both groups.   Considering hand function, no patient had normal hand grip after the first week, but after three weeks, a significantly higher proportion of patients in the Z-plasty reconstruction group had reached near normal hand grip (۷۶.۱% vs. ۲۹.۱%;). However, at weeks ۶ and ۱۲, the differences were not statistically different between the two groups.   Conclusion: We observed significant reduction in hand pain, shorter duration of hand pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL.  

Keywords:

Carpal tunnel syndrome , Hand Function , Median Neurolysis , Pillar Pain , Z-plasty