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Journal of the Korean Society for Surgery of the Hand 2006;11(3):174-179.
Published online September 1, 2006.
Modification of Camitz Opponensplasty Using Transverse Carpal Ligament Pulley in Patients with Carpal Tunnel Syndrome
Hyoung-Min Kim, Youn-Soo Kim, Kee-Haeng Lee, Changhoon Jeong, Chan-Woong Moon, Joo-Yup Lee, Chan-Kyu Kim, Il-Jung Park
수근관 증후군 환자에 대해 실시한 횡 수근 인대 활차를 이용한 Camitz 대립근 성형술의 변형
김형민, 김윤수, 이기행, 정창훈, 문찬웅, 이주엽, 김찬규, 박일중
Thenar muscle wasting is common in long standing severe carpal tunnel compression. Unfortunately, muscle wasting rarely recovers after decompression of the median nerve. In many cases, a single-staged procedure, combining carpal tunnel release and Camitz opponensplasty, has been used to treat severe carpal tunnel syndrome with thenar muscle atrophy. However, Camitz opponensplasty provided good effect to abduction, but little effect to flexion and pronation of thumb. This problem could be solved by making a pulley at transverse carpal ligament. Ten cases who had a longstanding carpal tunnel syndrome with severe thenar muscle atrophy and opposition inability were investigated. They were treated with open carpal tunnel release and modified Camitz opponensplasty simultaneously. All ten cases had at least 6 months follow-up period. Outcome was assessed by three indices; clinical grade of thenar atrophy, thumb opposition, and the patient’s satisfaction level. Clinical grade of thenar atrophy was improved from 3 to 0.83. Thumb opposition was assessed by means of three separate indices: maximal palmar abduction, spatial rotation, and thumb-to-finger apposition. The average maximal palmar abduction was 80%, spatial rotation was 89%, and symmetry of thumb-to-finger apposition was 88% of contralateral side at the last follow up. Patient’s satisfaction was divided by four grades. Nine patients were recorded as very satisfied or satisfied. Only one patient who had an adduction contracture of the thumb before the surgery was defined as less satisfied. By adding the pulley, it was possible to change the direction of palmaris longus closer to abductor pollicis brevis. Also the palmar flexion and the pronation of thumb could be further improved by using this technique. Modified Camitz opponensplasty is simple and effective procedure and provides reliable and immediate improvement of thenar function.
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