Interfascicular neurolysis in the severe carpal tunnel syndrome. A prospective, randomized, double-blind, controlled study

Abstract

There is significant difference of opinion whether an adjunctive interfascicular neurolysis will improve the results of lysis of the transverse carpal ligament in patients with severe carpal tunnel syndrome (thenar atrophy and/or fixed sensory deficit). Fifty such cases were prospectively and consecutively selected and then randomized into two groups prior to surgery. Half were treated by standard ligament release alone; the other half also had adjunctive interfascicular neurolysis. All patients had neurologic examination and nerve conduction studies performed by a "blind" examiner at one and three months postoperatively with comparison of these findings with preoperative data. Analysis of the data revealed no significant difference between the two groups and, therefore, demonstrated no benefit from adjunctive interfascicular neurolysis. Additionally, as the majority of patients in both groups improved significantly, the study demonstrated frequent benefit from transverse carpal ligament release even in the presence of fixed neurologic deficit in severe carpal tunnel syndrome.