. 2019 May 29;14:118. doi: 10.1186/s13023-019-1080-y

Table 11.

Guidance statements for decompression of the median nerve, tenosynovectomy and pulley release

Statement	Percentage consensus
Decompression of the median nerve and tenosynovectomy of all flexor tendons in the carpal tunnel is recommended in patients with MPS VI who display flexion contractures and distal interphalangeal (DIP) joints and/or proximal interphalangeal (PIP) joints (clawing), as well as clinical symptoms of hand pain and/or numbness in the thumb to middle finger, and in patients with positive nerve conduction studies Evidence Grade: C (level 4 studies)	89%
A1 and A3 pulley release is recommended in patients with MPS VI who display obvious trigger finger Evidence Grade: C (level 4 studies)	94%

Statement

Percentage consensus

Decompression of the median nerve and tenosynovectomy of all flexor tendons in the carpal tunnel is recommended in patients with MPS VI who display flexion contractures and distal interphalangeal (DIP) joints and/or proximal interphalangeal (PIP) joints (clawing), as well as clinical symptoms of hand pain and/or numbness in the thumb to middle finger, and in patients with positive nerve conduction studies

Evidence Grade: C (level 4 studies)

89%

A1 and A3 pulley release is recommended in patients with MPS VI who display obvious trigger finger

Evidence Grade: C (level 4 studies)

94%