Flexor Synovectomy as an Adjunct to Carpal Tunnel Release in Primary Carpal Tunnel Syndrome: A Meta-Analysis

Abstract

Background: Carpal tunnel release (CTR) aims to achieve surgical decompression of the median nerve for the treatment of carpal tunnel syndrome (CTS). Flexor tenosynovectomy (FS) has been carried out as an adjunct to routine CTR, on the basis that chronic flexor tenosynovitis has been implicated as an etiological factor in idiopathic CTS. However, the benefits of this additional procedure remains unclear. As such, we aimed to compare functional outcomes, nerve function and complication rates from CTR with and without FS. Methods: A systematic review of published literature was performed for original data English language studies comparing outcomes of CTR with and without FS in the treatment of primary CTS. Mean weighted differences and their 95% confidence interval were used for analysis. Results: Three studies comprising 292 wrists were included. Meta-analysis showed no improvement in post-operative grip strength, symptom severity score, functional status score, median nerve motor latency or major complications with FS. Recurrence rate was not reported in the 3 selected articles. Conclusions: The available evidence suggests FS is an unnecessary adjunct which provides no benefit to CTR, and should not be used routinely to treat primary CTS. Larger studies are needed to validate our findings. FS may have a role in recurrent or secondary CTS.

Keywords: Carpal tunnel syndrome; Synovectomy.