LETTERS TO THE EDITOR Carpal tunnel release effect on chronic thumb sucking To the Editor: I report an unusual result of a carpal tunnel release. The patient is a 32-year old, left-handed oil tank repairman and amateur body builder who had a left carpal tunnel release for treatment of carpal tunnel syndrome (CTS). On the fifth postoperative day he was seen for a dressing change. “Dot” he said, “I am embarrassed to tell you this but I am 32 years old and I have always sucked my thumb. As I can bench press twice my body weight, nobody has openly made fun of me. Usually I suck my thumb in the evening or in the morning while I am laying in bed. Over the years my mother and I have tried everything to get me to stop but nothing has worked. A day after my operation I tried to suck my thumb but something was wrong. The flavor seemed to have changed and it no longer gave me pleasure. I cleaned the thumb off but the flavor was still wrong. The next morning I tried to suck my thumb again, but in just was not right. I have no more desire to suck my thumb. I want want to thank you for curing me of my habit.” At 2 months after the operation he has no return of his carpal tunnel symptoms, or has he sucked his thumb. This case leads me to wonder what branch of the median nerve gives the thumb its flavor. Andrew M. Wexler, MD Department of Plastic Surgery Kaiser-Permanente Hospital 6041 Cadillac Ave. Los Angeles, CA 90034
“Carpal Tunnel Syndrome: Morphological Changes After the Release of the Transverse Carpal Ligament” To the Editor: I have enjoyed reading the article “Carpal tunnel syndrome; Morphological changes after the release of the transverse carpal ligament” (J HAND SURG 1989;141\:852-7). The authors clearly demonstrate by magnetic resonance imaging (MRI) that the increased postoperative volume of the carpal tunnel results from an anterior displacement of the divided flexor retinaculum. However, their statement that there have been no previous reports about this finding is not correct. In 1984 I did morphologic studies of the carpal canal by computed axial tomography in 13 patients before and
after division of the flexor retinaculum for the treatment of carpal tunnel syndrome, and I also arrived to the same conclusion as the authors have described. ’ This letter is not meant to be a criticism of the work or bibliographic research done by the authors of the article mentioned as I understand that it is practically impossible to have access to all publications in our “Tower of Babel.” Albert0 L. Lluch, MD, PhD Chief Hand Unit, Hospital Sant Pau Barcelona, Spain
REFERENCE 1. Lluch A. El Sindrome de1 Tune1 Carpiano. Barcelona: Ed
Mitre, 1987;108-10.
Reply I appreciate Dr. Lluch’s letter and regret not referencing his work in our article. Richard H. Gelberman, MD Massachusetts General Hospital WACC-427 Boston, MA 02114
PIP joint flexion contracture To the Editor: I read with considerable interest the article “A Splint for Controlled Active Motion after Flexor Tendon Repair,” by Chow et al. (J HAND SURG 1990;151\:64551), which reported that at 4 weeks the proximal interphalangeal (PIP) joint flexion contracture was present in 57% of flexor tendon repairs. Although they did not mention the incidence of PIP joint flexion contractures at 2 weeks (peak period), it is reasonable to assume that such a figure would be higher than 57%. This excellent study, along with another excellent study recently published by Small et al. ,’ support the notion that PIP joint flexion contractures are far more common than hitherto acknowledged and as a matter of fact they are part and parcel of this unresolved problem of zone 2 repairs (Khan, MI. New suture technique for flexor tendon repair: an experimental study. In: Proceedings of SIROT 5th general meeting, Montreal, 1990. Khan MI. Is the combination of a palmarly placed anchoring suture and controlled passive mobilization safe in the primary repair of flexor tendon lacerations? In: Proceedings of the Sixth Clinical Reunion of the Kleinert Society, Louisville, 1990).
THE
JOURNAL
OF HAND
SURGERY
379
“Carpal Tunnel Syndrome: Morphological Changes After the Release of the Transverse Carpal Ligament” To the Editor: I have enjoyed reading the article “Carpal tunnel syndrome; Morphological changes after the release of the transverse carpal ligament” (J HAND SURG 1989;141\:852-7). The authors clearly demonstrate by magnetic resonance imaging (MRI) that the increased postoperative volume of the carpal tunnel results from an anterior displacement of the divided flexor retinaculum. However, their statement that there have been no previous reports about this finding is not correct. In 1984 I did morphologic studies of the carpal canal by computed axial tomography in 13 patients before and
after division of the flexor retinaculum for the treatment of carpal tunnel syndrome, and I also arrived to the same conclusion as the authors have described. ’ This letter is not meant to be a criticism of the work or bibliographic research done by the authors of the article mentioned as I understand that it is practically impossible to have access to all publications in our “Tower of Babel.” Albert0 L. Lluch, MD, PhD Chief Hand Unit, Hospital Sant Pau Barcelona, Spain
REFERENCE 1. Lluch A. El Sindrome de1 Tune1 Carpiano. Barcelona: Ed
Mitre, 1987;108-10.
Reply I appreciate Dr. Lluch’s letter and regret not referencing his work in our article. Richard H. Gelberman, MD Massachusetts General Hospital WACC-427 Boston, MA 02114
PIP joint flexion contracture To the Editor: I read with considerable interest the article “A Splint for Controlled Active Motion after Flexor Tendon Repair,” by Chow et al. (J HAND SURG 1990;151\:64551), which reported that at 4 weeks the proximal interphalangeal (PIP) joint flexion contracture was present in 57% of flexor tendon repairs. Although they did not mention the incidence of PIP joint flexion contractures at 2 weeks (peak period), it is reasonable to assume that such a figure would be higher than 57%. This excellent study, along with another excellent study recently published by Small et al. ,’ support the notion that PIP joint flexion contractures are far more common than hitherto acknowledged and as a matter of fact they are part and parcel of this unresolved problem of zone 2 repairs (Khan, MI. New suture technique for flexor tendon repair: an experimental study. In: Proceedings of SIROT 5th general meeting, Montreal, 1990. Khan MI. Is the combination of a palmarly placed anchoring suture and controlled passive mobilization safe in the primary repair of flexor tendon lacerations? In: Proceedings of the Sixth Clinical Reunion of the Kleinert Society, Louisville, 1990).
THE
JOURNAL
OF HAND
SURGERY
379
