Objective To investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS). Methods The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The symptom duration of CTS was 12-120 months (mean, 48.7 months) and the thenar muscle atrophy duration was 6-48 months (mean, 13.4 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before operation and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up. Results All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There was no complications such as wound infection, scar pain of wrist, or tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation (P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation (P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied. Conclusion The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.
ObjectiveTo investigate the clinical characteristics of deep branch of the ulnar nerve injuries at the wrist and hand and to summarize the classification criteria. MethodsA retrospective analysis was conducted on 12 patients with deep branch of the ulnar nerve injuries at the wrist and hand admitted between November 2016 and September 2025, including 7 males and 5 females with an average age of 42.2 years (range, 17-69 years). The duration of injury ranged from 0.3 to 4.0 months (mean, 1.85 months). Two point discrimination (2-PD) of the little finger was 12 (4, 15) mm. The muscle strength of little finger abduction was rated as grade 3 in 1 case, grade 4? in 6 cases, and grade 5 in 5 cases. Pinch strength between the thumb and index finger was (2.88±0.49) kg. Wartenberg sign was positive in 10 cases and negative in 2 cases. The index-middle finger crossing test was positive and claw-hand deformity was present in all patients. Ten patients underwent surgical treatment, whereas 2 patients received conservative treatment. ResultsBased on the anatomical characteristics of the deep branch of the ulnar nerve, clinical manifestations, and intraoperative exploration findings, injuries to the deep branch of the ulnar nerve at the wrist and hand were classified into three types. Type Ⅰ injuries were located proximal to the pisohamate hiatus; type Ⅱ injuries were located between the pisohamate hiatus and a point 17 mm distal to the hook of the hamate; and type Ⅲ injuries were located distal to a point 17 mm distal to the hook of the hamate. Among the 12 patients, 7 were rated as type Ⅰ injuries, 3 as type Ⅱ injuries, and 2 as type Ⅲ injuries. All patients were followed up 6-108 months after treatment (median, 15.5 months). At last follow-up, 2-PD of the little finger improved to 6 (4, 6) mm; the muscle strength of little finger abduction improved to grade 5? in 3 patients and grade 5 in 9 patients; and pinch strength between the thumb and index finger increased to (6.53±1.12) kg. All differences between pre- and post-treatment were significant (P<0.05). Wartenberg sign, the index-middle finger crossing test, and claw-hand deformity were all negative. The all outcome indicators in the 7 patients with type Ⅰ injuries significantly improved when compared with those before treatment (P<0.05). Conclusion Based on the clinical characteristics and injury location, injuries to the deep branch of the ulnar nerve at the wrist and hand can be classified into three types. The pisohamate hiatus and the point 17 mm distal to the hook of the hamate on the palmar aspect are key anatomical landmarks for this classification. This classification system may facilitate accurate localization of deep ulnar nerve branch injuries and provide guidance for surgical planning.