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Optimizing carpal tunnel decompression: evaluating the significance of transligamentous thenar motor branch variations in severe carpal tunnel release

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Abstract

Background

While decompressing the median nerve, the thenar motor branch in the transligamentous variation may continue to remain under pressure of the transverse carpal ligament. It is aimed to present the long-term decompression results of patients with transligamentous thenar motor branch.

Methods

Between 2020 and 2022, patients diagnosed with severe CTS were included. The thenar motor branch was explored, and in patients with transligamentous variation (n = 16), the thenar motor branch was also decompressed. Grip strength, pinch strength, and the Boston Carpal Tunnel Syndrome Questionnaire were administered pre-surgery, three weeks postoperatively, and at one year.

Results

The results showed a significant increase in grip strength and palmar pinch strength and also improved motor functions and quality of life.

Conclusions

Despite the release of the transverse carpal ligament in transligamentous type thenar motor branch variations, motor strength may continue to decrease. It is suggested that in these patients, the ligament piece on the motor branch should also be excised additionally.

Level of Evidence

Level IV, Risk/Prognostic study.

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References

  1. Lanz U (1977) Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 2:44–53. https://doi.org/10.1016/s0363-5023(77)80009-9

    Article  CAS  PubMed  Google Scholar 

  2. Vashishtha K (2011) Variations of median nerve in Carpal Tunnel and its distribution in Hand. J Anat Soc India 60:193–198. https://doi.org/10.1016/S0003-2778(11)80025-0

    Article  Google Scholar 

  3. Alizadeh K, Lahiji F, Phalsaphy M (2006) Safety of carpal tunnelrelease with a short incision. A cadaver study. Acta OrthopBelg 72:415–419

    Google Scholar 

  4. Stancić MF, Eskinja N, Stosić A (1995) Anatomical variations of themedian nerve in the carpal tunnel. Int Orthop 19:30–34. https://doi.org/10.1007/BF00184911

    Article  PubMed  Google Scholar 

  5. Gutiérrez-Monclus RG, Gutiérrez-Espinoza HJ, Flores-Astudillo AR, Lluch-Homedes AL, Aguirre-Jerez M (2018) Release with or without reconstruction of the transverse carpal ligament for severe carpal tunnel syndrome: a randomized clinical trial. J Hand Surg Eur Vol 43:303–309. https://doi.org/10.1177/1753193417730260

    Article  PubMed  Google Scholar 

  6. Lutsky KF, Jones CM, Kim N, Medina J, Matzon JL, Beredjiklian PK (2017) Frequency of incidental median Thenar motor nerve branch visualization during Mini-open and endoscopic carpal tunnel release. Hand (N Y) 12:60–63. https://doi.org/10.1177/1558944716643095

    Article  PubMed  Google Scholar 

  7. Jegal M, Woo SJ, Lee HI, Shim JW, Shin WJ, Park MJ (2018) Anatomical relationships between Muscles Overlying Distal Transverse Carpal Ligament and Thenar Motor Branch of the median nerve. Clin Orthop Surg 10:89–93. https://doi.org/10.4055/cios.2018.10.1.89

    Article  PubMed  PubMed Central  Google Scholar 

  8. Al-Qattan MM (2010) Variations in the course of the Thenar Motor Branch of the median nerve and their relationship to the hypertrophic muscle overlying the Transverse Carpal Ligament. J Hand Surg Am 35:1820–1824. https://doi.org/10.1016/j.jhsa.2010.08.011

    Article  PubMed  Google Scholar 

  9. Vinding MT, Tarnowski JR, Benyahia MA (2010) Rare anatomical variant of the thenar branch discovered during open decompression of the median nerve. J Plast Surg Hand Surg 44:322–324. https://doi.org/10.3109/02844310903123379

    Article  PubMed  Google Scholar 

  10. Tate DE (2006) Isolated Fascial Compression of the Recurrent Motor Branch of the median nerve: a Case Report. Hand (N Y) 1:102–105. https://doi.org/10.1007/s11552-006-9006-2

    Article  PubMed  Google Scholar 

  11. Miyamoto H, Miura T, Morizaki Y, Uehara K, Ohe T, Tanaka S (2013) Comparative study on the stiffness of transverse carpal ligament between normal subjects and carpal tunnel syndrome patients. Hand Surg 18:209–214. https://doi.org/10.1142/S0218810413500251

    Article  PubMed  Google Scholar 

  12. Henry BM, Zwinczewska H, Roy J, Vikse J, Ramakrishnan PK, Walocha JA et al (2015) The prevalence of anatomical variations of the median nerve in the carpal tunnel: a systematic review and Meta-analysis. PLoS ONE 2510:e0136477. https://doi.org/10.1371/journal.pone.0136477

    Article  CAS  Google Scholar 

  13. Gellman H, Kan D, Gee V, Kuschner SH, Botte MJ (1989) Analysis of pinch and grip strength after carpal tunnel release. J Hand Surg Am 14:863–864. https://doi.org/10.1016/s0363-5023(89)80091-7

    Article  CAS  PubMed  Google Scholar 

  14. Young VL, Logan SE, Fernando B, Grasse P, Seaton M, Young AE (1992) Grip strength before and after carpal tunnel decompression. South Med J 85:897–900. https://doi.org/10.1097/00007611-199209000-00009

    Article  CAS  PubMed  Google Scholar 

  15. Bednarski M, Zyluk A, Zyluk B (2005) Changes of grip and pinch strength after carpal tunnel release. Chir Narzadow Ruchu Ortop Pol 70:21–26

    PubMed  Google Scholar 

  16. Lee SH, Gong HS (2022) Grip Strength Measurement for Outcome Assessment in Common Hand surgeries. Clin Orthop Surg 14:1–12. https://doi.org/10.4055/cios21090

    Article  PubMed  PubMed Central  Google Scholar 

  17. Candal-Couto JJ, Sher JL (2007) The thenar motor branch during carpal tunnel decompression: the expert opinion. Arch Orthop Trauma Surg 127:431–434. https://doi.org/10.1007/s00402-007-0341-8

    Article  CAS  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Faculty of Medicine, Hand Surgery Division, Department of Plastic, Reconstructive and Aesthetic Surgery, Selcuk University, Selcuklu, Konya, Türkiye

    Gokce Yildiran, Ahmet Rıfat Doğramacı & Zekeriya Tosun

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  1. Gokce Yildiran
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  2. Ahmet Rıfat Doğramacı
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  3. Zekeriya Tosun
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Contributions

GY and ARD researched literature and conceived the study. GY and ZT were involved in protocol development. ARD and GY were involved in gaining ethical approval, patient recruitment. GY and ARD were involved in analysing data. GY wrote the first draft of the manuscript. All authors reviewed approved the final version of the manuscript. ZT was the author who critically revised and edited the manuscript.

Corresponding author

Correspondence to Gokce Yildiran.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval for this study was obtained from Selcuk University Faculty of Medicine Local Ethics Committee (Approval no. 2020/06).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the evaluation data.

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The authors have no relevant financial or non-financial interests to disclose.

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Yildiran, G., Doğramacı, A.R. & Tosun, Z. Optimizing carpal tunnel decompression: evaluating the significance of transligamentous thenar motor branch variations in severe carpal tunnel release. Eur J Plast Surg 47, 43 (2024). https://doi.org/10.1007/s00238-024-02187-0

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  • DOI: https://doi.org/10.1007/s00238-024-02187-0

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