Back to 2013 Annual Meeting Program
Simultaneous Modified Camitz Opponensplasty Using a Pulley at Radial Flexor Retinaculum in Severe Carpal Tunnel Syndrome
Naoki Kato, MD, PhD; Takahiro Yoshizawa, MD; Hiroya Sakai, MD, PhD
Saitama Medical Center, Saitama Medical University, Kawagoe City, Japan
Introduction: Thenar muscle atrophy is a common finding in long-standing severe carpal tunnel syndrome (CTS). Camitz palmaris longus opponensplasty has been recognized as a safe and reliable opponensplasty in CTS, and the combination of open carpal tunnel release (OCTR) and Camitz opponensplasty has been used to treat these severe CTS patients. However, Camitz oppnensplasty does not meet the complete opposition, primarily because its orientation is radial to the ideal axis for opposition transfer. It supplies good abduction but provides little benefit to flexion and pronation. It is well known that tendon transfer in the direction of pisiformis from metacarpophalangeal joint is the most efficient for opposition transfer. In this respect, we made a key hole at radial side of the flexor retinaculum to alter the direction of the transferred palmaris longus tendon. We believe that these problems could be overcome by this modification.
Materials and Methods: Between 2009 and 2010, conventional Camitz oppnensplasty were performed in 7 patients, and from 2010, modified Camitz oppnensplasty using radial side of the flexor retinaculum as pulley were performed in 13 patients. In these 20 patients, we studied and compared the short term clinical outcome assessed by subjective and objective findings: radial and palmar abduction, pulp and side pinch strength, Kapandji score and DASH score.
Results: Both procedure showed immediate improvement of thenar function without any complications. Modified Camitz using a pulley showed further improvement in palmar abduction, pinch strength, Kapandji score and DASH score, comparing with conventional Camitz procedure.
Conclusion: In long-standing severe CTS, simultaneous modified Camitz opponensplasty using a pulley at radial flexor retinaculum is a simple and safe procedure that provides immediate improvement of thenar function.
Back to 2013 Annual Meeting Program