Forty patients on long-term hemodialysis with a second recurrence of carpal tunnel syndrome and concomitant loss of flexor tendon function due to adhesions were treated by excision of the flexor digitorum superficialis tendons. The mean carpal canal pressure measured 81 mmHg preoperatively and 10 mmHg after removal of all four tendons. Clinical symptoms of carpal tunnel syndrome were relieved and hand strength and finger motion were improved in 18 patients re-evaluated at a minimum follow-up of 6 months.
Long-term hemodialysis for management of renal failure may lead to amyloidal deposition in the flexor tendons, paratendons, and flexor retinaculum. The volume of the contents in the carpal canal is increased and may cause compression of the median nerve. Although primary carpal tunnel release surgery can be effective in improving symptoms of carpal tunnel syndrome in these cases, recurrent carpal tunnel syndrome is more difficult to treat. The authors have described a method of management which addresses both the flexor tendon adhesions and the volume mismatch in the carpal tunnel. They have reserved this procedure for hemodialysis patients undergoing surgery for a second recurrence of carpal tunnel syndrome with concomitant flexor tendon dysfunction.
J Hand Surg 29B:275-278, 2004.