Simultaneous Limited Incision Carpal Tunnel Release and Flexor Digitorum Superficialis Opponensplasty Using a Transverse Carpal Ligament Pulley: Surgical Technique and Case Series

Severe thenar muscle atrophy resulting in dysfunctional thumb abduction and opposition is a well-documented finding associated with long-standing severe carpal tunnel syndrome. This problem has been addressed in the past through various opposition tendon transfers. Historically, the Camitz procedure, or its modifications using the palmaris longus tendon, were recommended. However, this procedure requires a long incision in the palm, extensive dissection including the wrist area, and may not produce active thumb pronation. Our surgical technique describes an open limited palmar-only carpal tunnel release with ring finger flexor digitorum superficialis opponensplasty using a slit through the released transverse carpal ligament as a pulley and dual insertion of the tendon in both the extensor hood and the tendon of the abductor pollicis brevis. The Kapandji evaluation of thumb opposition was used to determine the outcome after surgery.