Carpal tunnel syndrome with thenar muscle atrophy: Camitz procedure + OCTR versus FDS4 opponensplasty + ECTR

People with severe carpal tunnel syndrome with thenar muscle atrophy suffer from loss of dexterity of the affected hand, which hinders their daily lives. There are different options for opponensplasty. The more traditional option is Camitz operation combined with open carpal tunnel release (OCTR). Another option is to use the flexor digitorum superficialis of the ring finger (FDS4) for opponensplasty and to combine it with endoscopic carpal tunnel release (ECTR). In this study, we prospectively compared the surgical outcomes of these two methods. A total of 27 cases were recruited (13 Camitz + OCTR; 14 FDS 4 + ECTR). Both groups showed good improvement in numbness, pulp-pinch strength, Kapandji score, thumb dexterity and hand function. The technique of FDS4 + ECTR had additional benefits of earlier restoration of thumb opposition and dexterity. In addition, FDS4 + ECTR was demonstrated to restore stronger pulp-pinch strength.