The Role of Palmar Cutaneous Branch Release in Enhancing Surgical Outcomes for Severe Carpal Tunnel Syndrome

Abstract

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and various surgical techniques are used for its treatment. Extended open carpal tunnel release (EOCTR) has been proposed for improved nerve decompression. This study compares the clinical and functional outcomes of open carpal tunnel release (OCTR) and EOCTR in severe CTS, hypothesizing superior functional outcomes and lower pain levels with EOCTR. Methods: This retrospective study included 53 patients (45 females, 8 males) with severe CTS confirmed by electromyography. Patients underwent either OCTR (n = 28) or EOCTR (n = 25) between January 2020 and February 2023. The EOCTR techinque involved additional neurolysis of the recurrent motor branch and palmar cutaneous branch of the median nerve. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the Visual Analog Scale (VAS) for pain, and hand strength measurements. Complications and recovery parameters were also analyzed. Results: EOCTR resulted in significantly lower postoperative VAS scores (3.31 vs. 3.78, p < 0.001), DASH scores (16.54 vs. 20.68, p < 0.001), and BCTQ symptom scores (1.87 vs. 2.01, p < 0.001). No significant differences were found in grip strength (p = 0.52) or pinch strength (tip-to-tip: p = 0.54, lateral: p = 0.061, 3-point: p = 0.17). No major complications occurred, and pillar pain was similar in both groups (p = 0.82), resolving with conservative treatment. Conclusions: EOCTR with additional palmar cutaneous branch of the median nerve neurolysis may provide better short-term functional outcomes and lower pain levels compared to OCTR in severe CTS. Further prospective studies are needed to validate the long-term benefits and safety of this surgical approach.

Keywords: carpal tunnel syndrome; median nerve; neurolysis; pain measurement; surgical decompression.

Figure 1

Selection process flow chart. CTS: Carpal tunnel syndrome.

Figure 2

(a) The classical approach incision (purple line): The black arrow indicates the Kaplan’s line (purple dashed line) and the white arrow indicates the radial side of the 4th finger (purple dashed line). (b) Extended approach incision (purple line): The Black arrow indicates the proximally extending lazy S incision, which begins at the Kaplan’s line (purple dashed line) at the radial side of the 4th finger (purple dashed line). (c) Extended approach: Release of the palmar cutaneous branch of the median nerve (black arrow) proximally and the recurrent motor branch (white arrow) distally.