Basal joint arthroplasty decreases carpal tunnel pressure

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Wrist Biomechanics

Background:

• Carpal tunnel syndrome (CTS) and thumb carpometacarpal (CMC) arthritis frequently coexist.
• A clinical observation suggests that patients undergoing thumb basal joint arthroplasty (BJA) rarely develop subsequent CTS.
• This led to the hypothesis that BJA may reduce carpal tunnel pressure.

Purpose of the Study:

• To investigate the effect of thumb basal joint arthroplasty (BJA) on intra-canal pressure within the carpal tunnel.
• To evaluate if BJA alone can decrease carpal tunnel pressure in patients with coexisting carpal tunnel syndrome (CTS).

Main Methods:

• A prospective study involving 28 patients undergoing BJA.
• Intra-canal pressure measurements were taken immediately before and after BJA using a digital pressure monitor.
• In patients with concomitant CTS, pressure was measured post-BJA and pre-transverse carpal ligament release.

Main Results:

• Carpal tunnel pressure decreased in all patients following BJA.
• Mean carpal tunnel pressure dropped from 23.9 mmHg pre-BJA to 11.0 mmHg post-BJA.
• In patients with CTS, mean pressure decreased from 26.5 mmHg to 7.3 mmHg after BJA.

Conclusions:

• Thumb basal joint arthroplasty (BJA) effectively decompresses the carpal tunnel, lowering intra-canal pressure.
• BJA alone significantly reduces carpal tunnel pressure in patients with coexisting CTS.
• Further research is needed to determine if a separate transverse carpal ligament release is necessary for CTS patients undergoing BJA.