Palmaris longus interposition in revision surgery for recurrent and persistent carpal tunnel syndrome: a case series

Figures & data

Figure 1. The incision in a cadaver. The previous incision is extended proximally and the carpal tunnel is opened. *: median nerve; Black arrow: ulnar leaf of flexor retinaculum; White arrow: palmaris longus tendon.

Figure 2. Intraoperative appearance in a cadaver. The palmaris longus tendon is dissected proximally. *: median nerve; Black arrows: flexor retinaculum; White arrow: palmaris longus tendon.

Figure 3. Interposition of the palmaris longus tendon in a cadaver. The palmaris longus tendon is flipped distally and sutured between the edges of the flexor retinaculum. *: median nerve; Black arrows: flexor retinaculum; White arrow: palmaris longus tendon.

Table 1. Patient characteristics of the study sample (n = 20 hands).

Categorical variables		n (%)
Sex	Female	11 (55)
Operated hand	Right	9 (45)
Recurrent symptoms		10 (50)
Comorbidities	Diabetes mellitus	4 (20)
	Hypertension	8 (40)
	Hypothyroidism	1 (5)
	Trigger finger	2 (10)
	Cubital tunnel syndrome	4 (20)
	CMC1 OA	2 (10)
Continuous variables		Mean (range)
Age (years)		54 (22–74))
BMI (kg/m^2)		31.6 (20.3–50.2)
Number of previous CTR’s		1.8 (1–4)
Time between first and last CTR (months) (median (range))		30 (7–432)
Follow-up (months)		15 (7–26)

BMI: body mass index; CMC1 OA: first carpometacarpal osteoarthritis; FSS: functional status scale; SSS: symptom severity scale.

Table 2. Pre- and intraoperative findings and postoperative outcomes.

Case No.	NCS severity	Ultrasono-graphy (mm^2)	Type of symptoms	Intraoperative findings	Course of symptoms	BCTQ SSS	BCTQ FSS	BCTQ total
1	Severe	14	Recurrent	Perineural fibrosis	Improvement	3.18	2.25	2.79
2	Moderate	15	Recurrent	Perineural fibrosis	No improvement	4.00	3.63	3.84
3	Moderate	18	Persistent	None	No improvement	4.45	4.13	4.32
4	Moderate	28	Persistent	Neuroma-in-continuity	Complete relief	1.18	1.50	1.32
5	Severe	8	Persistent	Perineural fibrosis	No improvement	3.09	3.38	3.21
6	Normal	12	Recurrent	None	No improvement	3.45	3.25	3.37
7	Severe	NA	Persistent	Incomplete release	Improvement	1.64	2.13	1.84
8	Mild	15	Recurrent	Perineural fibrosis	Improvement	2.36	2.50	2.42
9	Mild	11	Recurrent	None	Improvement	2.64	2.00	2.37
10	Severe	16	Recurrent	Perineural fibrosis	Complete relief	1.55	1.25	1.42
11	Mild	15	Persistent	None	Complete relief	1.36	1.63	1.47
12	Severe	18	Recurrent	Perineural fibrosis	Improvement	1.27	1.63	1.42
13.1	Severe	14	Persistent	None	Improvement	2.27	1.50	1.95
13.2	Severe	15	Persistent	Incomplete release	Improvement	2.27	1.50	1.95
14	Moderate	15	Persistent	Perineural fibrosis	Improvement	2.18	1.88	2.05
15.1	Mild	13	Recurrent	Incomplete release	Complete relief	1.09	1.50	1.26
15.2	Mild	13	Recurrent	None	Complete relief	1.09	1.50	1.26
16	Severe	20	Recurrent	None	Improvement	1.73	1.88	1.79
17	Mild	11	Persistent	Incomplete release	Worsening	3.09	3.00	3.05
18	Severe	18	Persistent	None	Improvement	1.18	1.63	1.37

BCTQ: Boston Carpal Tunnel Questionnaire; CTS: carpal tunnel syndrome; FSS: functional status scale; NA: not available, NCS: nerve conduction studies; SSS: symptom severity scale.