Do You Really Need That Camitz Transfer?

Adding a palmaris longus opponensplasty for patients with severe CTS makes a small operation much larger — what do you get in return?

Do You Really Need That Camitz Transfer?

What’s the Claim?

Surgeons disagree about how best to help patients with severe carpal tunnel syndrome, defined as those with no action potential to the abductor policis brevis at all. To try to clarify matters, a retrospective study compared carpal tunnel releases performed with and without a Camitz procedure (palmaris longus opponensplasty) and found the added tendon transfer did not improve patients’ scores on the Carpal Tunnel Syndrome Instrument questionnaire. Not surprisingly, the groups didn’t differ in terms of motor action potentials to the APB, and those did not fully recover; the authors suggested that other synergistic muscles acting on the thumb and sensory recovery may have helped improve thumb opposition.

How’s It Stack Up?

There are enough case series about the Camitz transfer (and its many modifications) for this indication that review articles have covered the topic. What we’ve lacked, until now, is a reasonable comparative series of whether the intervention is really all that helpful. It appears, perhaps, that it may not be — or at least it ought to be used more selectively.

We note that this study included only patients with very severe carpal tunnel syndrome — those with a compound muscle action potential to the APB of zero —who would be considered reasonable candidates for the Camitz procedure. Our main beef with this study was that it wasn’t clear why some of those patients received a tendon transfer during the study period and others did not. It’s probably best to assume that those who did either had more-severe clinical presentations or higher perceived demand in terms of thumb opposition. Loss to follow-up was more severe at a year in the CTR-alone group, but at 6 months (a reasonable interval) it didn’t differ between the groups, and so we have reasonable confidence that the study didn’t lose the unhappiest patients before the research team could see how they were doing. The authors analyzed their dataset eight ways to Sunday and couldn’t turn up anything that looked like an advantage to the group that had the extra procedure.

What’s Our Take?

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Smart Practice: Think twice before adding a Camitz procedure to your carpal tunnel releases in patients without APB motor action potentials, as this study suggests it doesn't deliver any discernible improvement.

Since every procedure we perform adds risk, cost, and potential morbidity, the findings here would cause us to rethink whether to perform a Camitz procedure, and generally lean away from doing so. The authors’ suggestion that the surgeon consider the patient’s expectations regarding restoration of pinch function is reasonable.

Source

Doi K, Marei AE, Mane SA, et al. Re-evaluation of the Indications for the Camitz Procedure in Severe Carpal Tunnel Syndrome. J Hand Surg Am. 202312:S0363-5023(23)00171-5.