Postoperative changes of carpal canal pressure in carpal tunnel syndrome: a prospective study with follow-up of 1 year

Carpal canal pressures were measured in 103 patients with idiopathic carpal tunnel syndrome, before and after open release, with a postoperative follow-up of 1 year. Twenty-five normal subjects were used as controls. Pressures were measured with the wrists in three positions: neutral, full passive flexion and full passive extension. At each wrist position, the mean pre-operative pressures in the study group were significantly higher than in the control group. In both groups, the pressures were maximal with full passive extension and minimal in the neutral wrist position. Immediately after surgical release, there was a marked decrease of the carpal canal pressures. However, during the second postoperative month, there was a significant increase of the pressures at each wrist position, although these were still within the normal control range. This rise in pressures persisted to 12 months. These findings suggest that the carpal ligament reconstitutes by normal scar formation, but with lengthening such that the volume of the carpal canal is enlarged, so preventing a rise in pressure with return of the pre-operative problem.