Adjunctive internal neurolysis of the median nerve followed by release of the transverse carpal ligament is widely performed for treating carpal tunnel syndrome. However, the efficacy of internal neurolysis is still controversial. In this series, eleven hands in eleven patients had internal neurolysis of the median nerve and carpal tunnel release, twelve hands in eleven patients had standard ligament release alone.
Thenar muscle strength and bulk were recorded in all hands. Median nerve function was evaluated using the two-point discrimination test and electromyography. Preoperatively, all hands had severe thenar muscle atrophy with no motor response to stimulation.
Analysing the postoperative data, the majority of hands in both groups achieved satisfactory results and there was no significant difference between the results of the two groups. Results of this study indicate that standard surgical release of the transverse carpal ligament is equally effective in patients with severe carpal tunnel syndrome. Therefore, it can be suggested that internal neurolysis is not necessary in the treatment of carpal tunnel syndrome.