Outcome following epineurotomy in carpal tunnel syndrome: a prospective, randomized clinical trial

To assess the efficacy of an adjunctive epineurotomy in carpal tunnel syndrome, 36 wrists in 33 patients were prospectively randomized into epineurotomy and non-epineurotomy treatment groups. The operating surgeons and evaluating therapist were double-blinded. Patients were evaluated preoperatively and at either 6 or 12 months postoperatively, with 15 patients examined at both postoperative time points. Evaluation consisted of five sensory and four motor tests: static and moving two-point discrimination, Semmes-Weinstein monofilament testing, vibratory (30 and 256 cps) sensibility, and dynamometer testing of grip strength and lateral, three-jaw, and tip pinch strengths. Sensory testing showed overall improvement within both groups postoperatively, but there was no difference between the two groups at either 6 or 12 months postoperatively. Motor testing revealed no improvement in the grip strength or lateral, three-jaw, or tip pinch of either group at 12 months when compared to preoperative levels. Twenty-four of 26 epineurotomy patients and all 10 control patients were satisfied with their clinical outcome 30 months after surgery. The addition of an adjunctive epineurotomy, although safe, offered no clinical benefit in the surgical treatment of carpal tunnel syndrome in this series.