Comparison of Ligament Z-Plasty and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Randomized Clinical Trial.

BACKGROUND

Conventional surgery performed to treat carpal tunnel syndrome (CTS) is associated with complications such as pillar pain or loss of strength. This study aimed to compare the incidence of pillar pain between 2 techniques at the 3-week and 6-month follow-up and to determine differences in the recovery of grip strength (GS), pinch strength (PS), and Boston Carpal Tunnel Questionnaire scores.

METHODS

This randomized clinical trial included 109 patients, 55 of whom underwent ligament Z-plasty and 54, conventional surgery (longitudinal section of the transverse carpal ligament without posterior closure). GS, PS, pillar pain, and Boston Carpal Tunnel Questionnaire scores were assessed preoperatively and 3 weeks and 6 months after surgery.

RESULTS

The incidence of pillar pain 3 weeks after surgery was lower in patients undergoing Z-plasty than in those undergoing conventional surgery (25.5% versus 44.4%; P = 0.04). Moreover, the absolute change in PS 3 weeks after surgery ( P = 0.01) and GS 6 months after surgery ( P = 0.05) and the absolute and relative changes in PS after 6 months ( P = 0.008 and P = 0.01, respectively) were significantly higher in the Z-plasty group than in the conventional surgery group.

CONCLUSIONS

Z-plasty is a valid surgical procedure for treating CTS. It is associated with a lower incidence of pillar pain and better recovery of postoperative strength compared with the conventional surgical technique, with both techniques showing similar results in CTS recovery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.