Comparison of Partial Flexor Retinaculum Release Sparing Transverse Carpal Ligament and Antebrachial Fascia With Complete Flexor Retinaculum Release in the Management of Moderate to Severe Carpal Tunnel Syndrome

Background and Aims: Carpal tunnel syndrome (CTS) is the most prevalent peripheral mononeuropathy affecting the median nerve. It can be managed with physiotherapy, localised steroid injections, or surgery. Our study compared outcomes of two surgical techniques, that is, partial flexor retinaculum release (FRR) and conventional complete FRR in moderate to severe CTS. Methods: It was a single-blinded cohort study conducted at Mayo Hospital, Lahore, Pakistan, over a 12-month period in 2022. Sampling was stratified random with a total sample size of 66. Inclusion criteria were patients between 18 and 70 years of age, having Grade 3 to 6 CTS (Bland electrophysiological classification), having undergone at least one localised steroid injection on the symptomatic side, with no other spinal cord deformities. The rest were excluded. Interventions studied were complete FRR and partial FRR, sparing transverse carpal ligament and antebrachial fascia. Data was analysed using the statistical package for social sciences (SPSS) Version 26. Analytic tests used were chi-square test, linear-to-linear test, independent sample t-test and Mann–Whitney U test with a p value of <0.05. Results: Partial FRR was done in 34 patients (51.51%) and complete FRR in 32 patients (48.48%). There was no significant difference in postoperative outcomes when compared independently. Linear regression analysis showed a significant role of partial FRR in predicting postoperative Boston questionnaire for symptom severity scale (BQSSS) scores (p = 0.021) and Boston questionnaire for functional severity scale (BQFSS) scores (p = 0.045) when other independent variables are accounted. No such relationship was demonstrated with postoperative visual analogue scale (VAS) scores (p = 0.531). Interpretation: Partial FRR is a novel technique for the management of CTS, resistant to local steroid administration. This technique showed no significant difference in postoperative outcomes from its traditional counterpart, with a possibility of improved postoperative structural and functional recovery that needs further evaluation.