Background: It was hypothesized that preserving a layer of gliding
tissue, the parietal layer of the ulnar bursa, between the contents of the
carpal tunnel and the soft tissues incised during carpal tunnel surgery might
reduce scar pain and improve grip strength and function following open carpal
Methods: Patients consented to randomization to treatment with
either preservation of the parietal layer of the ulnar bursa beneath the
flexor retinaculum at the time of open carpal tunnel decompression
(fifty-seven patients) or division of this gliding layer as part of a standard
open carpal tunnel decompression (sixty-one patients). Grip strength was
measured, scar pain was rated, and the validated Patient Evaluation Measure
questionnaire was used to assess symptoms and disability preoperatively and at
eight to nine weeks following the surgery in seventy-seven women and
thirty-four men; the remaining seven patients were lost to follow-up.
Results: There was no difference between the groups with respect to
age, sex, hand dominance, or side of surgery. Grip strength, scar pain, and
the Patient Evaluation Measure score were not significantly different between
the two groups, although there was a trend toward a poorer subjective outcome
as demonstrated by the questionnaire in the group in which the ulnar bursa
within the carpal tunnel had been preserved. Preserving the ulnar bursa within
the carpal tunnel did, however, result in a lower prevalence of suspected
wound infection or inflammation (p = 0.04).
Conclusions: In this group of patients, preservation of the ulnar
bursa around the median nerve during open carpal tunnel release produced no
significant difference in grip strength or self-rated symptoms. We recommend
incision of the ulnar bursa during open carpal tunnel decompression to allow
complete visualization of the median nerve and carpal tunnel contents.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.