Randomized Controlled Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2017; 8(11): 846-852
Published online Nov 18, 2017. doi: 10.5312/wjo.v8.i11.846
Hypothenar fat pad flap vs conventional open release in primary carpal tunnel syndrome: A randomized controlled trial
Thepparat Kanchanathepsak, Wilarat Wairojanakul, Thitiporn Phakdepiboon, Sorasak Suppaphol, Ittirat Watcharananan, Tulyapruek Tawonsawatruk
Thepparat Kanchanathepsak, Wilarat Wairojanakul, Sorasak Suppaphol, Ittirat Watcharananan, Tulyapruek Tawonsawatruk, Hand and Microsurgery Unit, Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Thitiporn Phakdepiboon, Department of Physical Medicine and Rehabilitation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Kanchanathepsak T, Wairojanakul W, Suppaphol S, Watcharananan I and Tawonsawatruk T designed the research; Kanchanathepsak T, Wairojanakul W, Phakdepiboon T, Tawonsawatruk T performed the research; Kanchanathepsak T and Tawonsawatruk T analysed the data; Kanchanathepsak T, Wairojanakul W and Tawonsawatruk T wrote the manuscript and made the final approval of the version to be published.
Clinical trial registration statement: This study is registered at www.clinicaltrials.in.th. The registration identification number is TCTR20170719002.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tulyapruek Tawonsawatruk, MD, PhD, Hand and Microsurgery Unit, Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand. tulyapruek.tao@mahidol.ac.th
Telephone: +66-2-2011589 Fax: +66-2-2011599
Received: January 23, 2017
Peer-review started: February 2, 2017
First decision: June 26, 2017
Revised: July 10, 2017
Accepted: September 3, 2017
Article in press: September 4, 2017
Published online: November 18, 2017
Abstract
AIM

To compared outcomes between the hypothenar fat pad flap (HTFPF) and conventional open carpal tunnel release (COR) in primary carpal tunnel syndrome (CTS).

METHODS

Forty-five patients (49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients (41 hands) by computer generated (Block of four randomization) into COR and HTFPF group. Nerve conduction study (NCS) included distal sensory latency (DSL), distal motor latency (DML), sensory amplitude (S-amp), motor amplitude (M-amp) and sensory nerve conduction velocity (SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale (VAS)], 2-point discrimination (2-PD), Semmes-Weinstein monofilament test (SWM), Phalen test and Tinel’s sign were evaluated in order to compare treatment outcomes.

RESULTS

The COR group, 19 patients (20 hands) mean age 50.4 years. The HTFPF group, 20 patients (21 hands) mean age 53.3 years. Finally 33 patients (36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk (P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups (P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain (VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel’s sign were improved postoperatively in both groups, but there was no significant difference between two groups.

CONCLUSION

There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.

Keywords: Hypothenar fat pad flap, Randomized controlled trial, Carpal tunnel release, Carpal tunnel syndrome, Nerve conduction study

Core tip: The study conducted a randomized controlled trial to compare between the hypothenar fat pad flap additional and conventional open carpal tunnel release in primary carpal tunnel syndrome. The study showed no advantage, however improvement of nerve conduction study was observed in the early postoperatively.