This study assessed the predictability of postoperative recovery of thumb opposition in patients with carpal tunnel syndrome and undetectable compound muscle action potential of the abductor pollicis brevis (APB-CMAP). Thirty-seven hands of 33 patients with a mean age of 59.8 years old were reviewed one year or longer after carpal tunnel release surgery, with a mean follow-up period of 39 months. Thenar muscle atrophy had disappeared in 21 hands (57%), all of which had detectable APB-CMAPs. Thenar muscle atrophy persisted in 16 hands (43%), among which APB-CMAPs were detectable in 7 hands and remained undetectable in 9 hands. Disease duration preceding surgery did not differ significantly between the hands in which muscle atrophy disappeared and the hands in which muscle atrophy persisted. Thenar atrophy disappeared in all seven patients under 50 years of age at the time of carpal tunnel release, but persisted in 16 of the 30 (53%) patients over 50 years of age. These findings indicate that good recovery of thumb opposition can be expected without opponensplasty in patients less than 50 years of age. However, recovery was not predictable in patients over 50 years of age.

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We estimated the severity of higher brain dysfunction according to the Ministry of Health, Labour and Welfare classification for 113 patients with higher brain dysfunction, and analyzed the correlation between severity and actual employment rate, based on neuropsychological findings and social behavioral disturbance. The actual job rate was similar to the theoretical one, which was determined by the Ministry's severity classification and was then correlated with the patient's neuropsychological findings (WAIS-R, RBMT, TMT-B and social cognition). In patients with a similar degree of severity, these neuropsychological findings did not affect their employment or unemployment. Our study demonstrated that the theoretical employment rate determined using the Ministry's classification was similar to the real one, and suggested that non-personal factors were responsible for the differences in employment rates in patients with the same severity of dysfunction.

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Risk Factor of Medial Knee Osteoarthritis…Go OMORI 85

Selection of Treatments for Osteoarthritis of the Knee…Hiroshi IKEDA 89

Rehabilitation as Conservative Treatment for Osteoarthritis of the Knee…Hidetoshi IHARA, Toshiro ISHIBASHI 94

Clinical Pathway and Rehabilitation of Total Knee Arthroplasty for Osteoarthritis…Hironobu KOTANI 99

Critical Pathway of Osteoarthritis and Local Health Care…Kazutoshi NOMURA 105

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