Introduction: The prevalence of carpal tunnel syndrome (CTS) in patients with thumb carpometacarpal (CMC) arthritis may be as high as 43%. Because unrecognized CTS in thumb arthroplasty patients can result in additional postoperative pain and weakness and even precipitate a reflex sympathetic dystrophy following thumb CMC arthroplasty, some advocate simultaneous carpal tunnel release (CTR). Purpose: To demonstrate the safety and efficacy of a combined radial-sided CTR and a thumb CMC arthroplasty via a single incision. Methods: Over an 11 month period, 8 patients (M:F=1:7) with an average age of 53.8 (range 38-70) years who had both thumb CMC arthritis and CTS underwent CMC arthroplasty with ligament reconstruction and CTR via a radial approach through the thumb CMC arthroplasty incision. All patients had thumb CMC arthritis and CTS based on history, physical, and ancillary tests and had all failed conservative therapy consisting of oral anti-inflammatory medications, splinting, and steroid injection. All patients underwent thumb CMC arthroplasty with trapezial resection and joint debridement. CTR was then performed through the same incision, dividing both superficial and deep portions of the transverse carpal ligament (TCL). Results: Six right-sided and two left-sided procedures were performed, three for recurrent CTS following open procedures. Four patients had additional procedures under the same axillary block (excisions of 2 ganglions and a subcutaneous forearm mass, and DeQuervain’s and trigger finger release). Follow-up averaged 14 (range: 1.7-24.8) weeks. All patients had improved pain and numbness. No recurrent motor branch nor sensory nerve injuries were observed. Conclusion: It is not uncommon to have patients with both thumb CMC arthritis and CTS. We have found that a thumb CMC arthroplasty and CTR may be safely performed together through the same incision by using a radial approach to the division of the TCL.
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