Recovery from thenar atrophy, constant finger numbness occurs after carpal tunnel release
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Reversal of symptoms of sensibility and thenar atrophy after carpal tunnel release is possible based on a study of 36 patients whose 41 hands — most of which presented with both symptoms — were followed up for 12 months, a presenter said.
Summarizing the results of the study during a presentation at the American Society for Surgery of the Hand Annual Meeting, Maheen Nadeem, MD, an orthopedic surgery resident at University of Pittsburgh Medical Center Hamot in Erie, Pennsylvania, said, “In severe presentations of carpal tunnel syndrome, it is rare to have thenar atrophy (TA) without associated constant fingertip numbness. Despite advanced disease, patients can still reasonably expect return of functional hand strength and outcomes, potentially complete resolution of numbness and return of thenar muscle bulk. Surgeons can be optimistic with patients in regard to functional outcomes in median nerve decompression in even advanced forms of carpal tunnel syndrome disease.”
Nadeem and colleagues prospectively evaluated patients through data collected at the first postoperative visit following carpal tunnel release (CTR) and again at 3 months, 6 months and 12 months after surgery. Researchers measured key pinch strength and grip strength with dynamometers and used the quick DASH (qDASH) score for functional outcomes, for which they defined a score of 4 or more to mean dissatisfaction with function. They tested sensibility with Semmes-Weinstein monofilament testing, using standard definitions and testing patients’ first three fingers separately. In addition, researchers measured thenar atrophy in millimeters with a direct measurement device.
“Based on percent of patients passing their preoperative baseline, key pinch strength lagged behind improvement in grip strength, but ultimately showed higher proportions of patients surpassing their baseline values, approaching 100% at 1 year,” Nadeem said. “Additionally, patients with TA showed larger improvements in key grip strength than the constant numbness (CN) counterparts.”
Although baseline qDASH scores showed 80% of patients were initially dissatisfied with their functional outcomes, at 3 months about 20% of patients reported still being dissatisfied “and 100% satisfaction at 6 months,” Nadeem said.
Compared with baseline, Semmes-Weinstein test results showed three-fourths of the CN group had improvement in their tested digits at 6 months and one-third of the group returned to normal sensation, she said.
TA, which was measured at 1.6 mm plus or minus - 0.8 mm average at baseline, “continued to reverse over time at all future timepoints, with latest follow-up showing atrophy of 0.3 [mm] ± - 0.6 mm,” Nadeem said.
“While the rate of recovery of CN and TA differ following CTR, both showed significant improvement from CTR,” the researchers wrote in the abstract.
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Nadeem M, et al. Paper 1. Presented at: American Society for Surgery of the Hand Annual Meeting. Sept.30 - Oct. 2, 2021; San Francisco (hybrid meeting).
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