Original Articles
Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longitudinal assessment in patients older than age 701

https://doi.org/10.1016/j.jhsa.2004.02.003Get rights and content

Abstract

Purpose

Advanced stages of nerve compression are likely to result in irreversible intraneural changes including intrinsic fibrosis and axon loss, and advanced age is expected to compromise nerve regeneration and recovery. Although satisfactory outcomes have been reported we hypothesized that carpal tunnel release in an elderly population with advanced carpal tunnel disease might not significantly improve symptom severity, functional status, or grip strength compared with before surgery. Our purpose was to evaluate these 3 parameters both before and after surgery to assess the efficacy of surgical intervention.

Methods

Between October 2000 and January 2002 a total of 13 patients (14 hands) were enrolled into a prospective longitudinal study. Entry criteria included advanced carpal tunnel syndrome based on neurophysiologic studies (absent sensory latencies and positive fibrillation potentials), clinical examination (thenar atrophy), and age over 70 years. Exclusion criteria included cervical disease, prior surgery, concomitant surgery, diabetic neuropathy, and associated cubital tunnel syndrome. There were 7 men and 6 women with an average age of 79 years (range, 72–90 y). With the help of a neutral observer each patient completed the Brigham and Women’s validated carpal tunnel syndrome questionnaire before and 6 and 12 months after surgery to assess symptom severity and functional status. Grip strength was measured before and at 1 year after surgery and each patient also was asked to rate their level of satisfaction with their outcome at 1 year after surgery.

Results

Before surgery the mean symptom severity score was 29 based on a scale in which a minimum score of 11 reflects no symptoms and a maximum score of 55 reflects severe symptoms. The mean functional status score was 18 on a scale in which a minimum score of 8 reflects no difficulty and a high score of 40 reflects severe impairment. Six months after surgery the mean symptom severity score decreased from 29 to 15 (11 reflects no symptoms) and the average functional status score decreased from 18 to 11 (8 reflects no difficulty). One year after surgery the symptom severity score decreased from 15 to 14 and the functional status score decreased from 11 to 9. Compared with scores before surgery the improvements at 6 months and 1 year were statistically significant. Patient satisfaction was noted for 13 of 14 hands. Average grip strength remained unchanged after surgery.

Conclusions

Carpal tunnel release is unlikely to result in a total elimination of symptoms and complete restoration of function when performed in elderly patients with advanced disease. Although grip strength did not improve at final follow-up evaluation, symptom severity and functional status did improve from the patient’s perspective. We conclude that carpal tunnel release is efficacious in this subset of patients.

Section snippets

Materials and methods

We performed a prospective longitudinal study of patients aged 70 years or older who had an open carpal tunnel release for carpal tunnel syndrome between October 2000 and January 2002. This study population was entirely unique and not previously reported.7 Entry criteria for the study included advanced neurophysiologic changes including an absence of sensory response after stimulation, an increase in median distal motor latency of greater than 6.0 ms, and abductor pollicis brevis fibrillation

Results

Before surgery all patients were symptomatic with a mean preoperative symptom severity score of 28.5 ± 10.3. A maximum score of 55 on the symptom severity scale indicates severe symptoms and a minimum score of 11 reflects no symptoms. At 6 months and 1 year after surgery the mean symptom severity scores were 14.7 ± 2.9, and 13.8 ± 3.5, respectively. These improvements were statistically significant at 6 months (p < .0002) and 1 year (p < .0002). Changes in symptom severity scores between 6

Discussion

Although carpal tunnel release can improve clinical symptoms and electrophysiologic parameters even in cases of long-standing nerve compression,5, 10 complete clinical recovery and significant electrophysiologic improvement are most likely when surgery is performed at a very early stage.11 Indeed the association between stage of disease and intraneural microvascular dysfunction and nerve fiber injury has been clearly established12; thus, poor predictors of outcome may include muscle weakness or

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