Temporal changes in grip and pinch strength after open carpal tunnel release and the effect of ligament reconstruction

Symptoms of pain and weakness are nearly ubiquitous after carpal tunnel release. This study investigates the length of time before restoration of grip and pinch strength after open carpal tunnel release, in a population of patients without workers' compensation-related injuries. Two different forms of carpal ligament reconstruction were carried out in 2 groups of patients, and a third group underwent no ligament reconstruction. Grip and pinch strengths were measured for participants in each group both preoperatively and at set postoperative intervals. Mean changes in strength were calculated and analysis of variance used to determine statistical significance of the changes. Grip strength at 6 weeks after surgery in the group that underwent transposition flap repair exceeded preoperative grip strength values and all 3 groups surpassed preoperative grip strength measurements at 12 weeks. By 6 weeks after surgery, all pinch measurements for 3 groups equaled or exceeded preoperative pinch measurements. The transposition flap repair group recovered faster than did the other 2 groups and surpassed those groups in maximum grip and pinch strength at 12 weeks. These results suggest that transverse carpal ligament reconstruction, particularly the transposition flap technique, after open carpal tunnel release confers a mechanical advantage and that the transverse carpal ligament is an important pulley in flexor tendon excursion.