Neurolysis: There was one high quality study (Mackinnon 1991) and one moderate quality study (Lowry 1988) which evaluated the addition of neurolysis of the median nerve to a standard carpal tunnel release. The Mackinnon study focused on internal neurolysis and found no differences in thenar atrophy, muscle strength, pressure threshold, vibration threshold and static two-point discrimination at 12 months after surgery. No difference was noted in pinch or grip strength. The Lowry study evaluated the NCS findings at 3 months after surgery and did not find a difference in nerve conduction velocity or distal motor and sensory latency. Neither study found a difference in symptom relief or recurrence.
Flexor Tenosynovectomy: There was one high quality study (Shum 2002) evaluating flexor tenosynovectomy as an adjunct to carpal tunnel release. There was no difference in surgical site infection, scar sensitivity, wrist motion, finger motion, or Boston Carpal Tunnel Questionnaire at 12 months following surgery.
Flexor Retinaculum Reconstruction/Lengthening: There was one high quality study (Dias 2004) that evaluated flexor retinaculum lengthening/reconstruction. Six months following surgery there were no differences in grip strength, Jebsen Taylor score, Phalen test, pinch strength, Boston Carpal Tunnel Questionnaire score or symptom recurrence.
- -Crnkovi?-T; -Bili?-R; Trkulja,V.; Cesarik,M.; Gotovac,N.; -Kolund?i?-R The effect of epineurotomy on the median nerve volume after the carpal tunnel release: a prospective randomised double-blind controlled trial. Int.Orthop.; 2012: 0
- Blair,W.F.; Goetz,D.D.; Ross,M.A.; Steyers,C.M.; Chang,P. Carpal tunnel release with and without epineurotomy: a comparative prospective trial. J Hand Surg Am; 1996/7: 4
- Dias,J.J.; Bhowal,B.; Wildin,C.J.; Thompson,J.R. Carpal tunnel decompression. Is lengthening of the flexor retinaculum better than simple division?. J Hand Surg Br; 2004/6: 3
- Leinberry,C.F.; Hammond,N.L.,III; Siegfried,J.W. The role of epineurotomy in the operative treatment of carpal tunnel syndrome. J Bone Joint Surg Am; 1997/4: 4
- Lowry,W.E.,Jr.; Follender,A.B. Interfascicular neurolysis in the severe carpal tunnel syndrome. A prospective, randomized, double-blind, controlled study. Clin Orthop Relat Res.; 1988/2: 0
- Mackinnon,S.E.; McCabe,S.; Murray,J.F.; Szalai,J.P.; Kelly,L.; Novak,C.; Kin,B.; Burke,G.M. Internal neurolysis fails to improve the results of primary carpal tunnel decompression. J Hand Surg Am; 1991/3: 2
- Shum,C.; Parisien,M.; Strauch,R.J.; Rosenwasser,M.P. The role of flexor tenosynovectomy in the operative treatment of carpal tunnel syndrome. J Bone Joint Surg Am; 2002/2: 2