Results of treatment of severe carpal-tunnel syndrome without internal neurolysis of the median nerve.

Thirty-three hands (twenty-nine patients) had a release of the carpal tunnel without internal neurolysis for severe carpal-tunnel syndrome. All of the hands had increased values for two-point discrimination or thenar atrophy, or both. Twenty-three (89 per cent) of the twenty-six hands that had increased values for two-point discrimination and twenty-six (87 per cent) of the thirty hands that had an elevated result on Semmes-Weinstein testing had normal values at follow-up. Nine (90 per cent) of the ten hands that had weakness of the thenar muscles (grade-3 strength or less) regained grade-4 or 5 strength. Thirteen (65 per cent) of the twenty hands that had thenar atrophy regained normal muscle bulk. Eighteen (62 per cent) of the twenty-nine patients had complete resolution of symptoms and signs of compression of the median nerve. No significant difference was found between the results in this series of patients and those in a previously reported similar group of patients who were treated by release of the carpal tunnel combined with internal neurolysis of the median nerve.