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Acta Neurochirurgica

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01-04-2019 | Neurological Tests | Original Article - Peripheral Nerves

Long-term outcome after carpal tunnel release and identification of prognostic factors

Authors: Floriaan G. C. M. De Kleermaeker, Jan Meulstee, Ronald H. M. A. Bartels, Wim I. M. Verhagen

Published in: Acta Neurochirurgica | Issue 4/2019

Abstract

Background

The effectiveness of the surgical treatment of carpal tunnel syndrome (CTS) is well known on short term. However, limited data is available about long-term outcome after carpal tunnel release (CTR). The aims of this study were to explore the long-term outcome after CTR and to identify prognostic factors for long-term outcome.

Methods

Patients with clinically defined CTS underwent CTR and completed the Boston Carpal Tunnel Questionnaire at baseline (T₀), at about 8 months (T₁), and after a median follow-up of 9 years (T₂), as well as a 6-point scale for perceived improvement (at T₁ and T₂). Potentially prognostic factors were identified by logistic regression analysis and correlation.

Results

At long-term follow-up, 87 patients (40.3%) completed the questionnaires. Mean score on Symptom Severity Scale (2.87 to 1.54; p < 0.001) and Functional Status Scale (2.14 to 1.51; p < 0.001) improved at 8 months and did not change significantly after 8 months. A favorable outcome was reported in 81.6%. A good treatment outcome after 8 months and to a lesser extent a lower FSS score at T₀ were associated with a better long-term outcome.

Conclusions

CTR is a robust treatment for CTS and its effect persists after a period of 9 years. The most important factor associated with long-term outcome is treatment outcome after about 8 months and to a lesser extent functional complaints preoperatively. Outcome is independent of patient characteristics, electrodiagnostic test results, or findings at the initial neurological examination.

Atroshi I, Hofer M, Larsson GU, Ranstam J (2015) Extended follow-up of a randomized clinical trial of open vs endoscopic release surgery for carpal tunnel syndrome. JAMA 314:1399–1401. https://doi.org/10.1001/jama.2015.12208 CrossRefPubMed

Bland JD (2001) Do nerve conduction studies predict the outcome of carpal tunnel decompression? Muscle Nerve 24:935–940CrossRefPubMed

Braun RM, Jackson WJ (1994) Electrical studies as a prognostic factor in the surgical treatment of carpal tunnel syndrome. J Hand Surg [Am] 19:893–900. https://doi.org/10.1016/0363-5023(94)90086-8 CrossRef

Chen SJ, Lin HS, Hsieh CH (2013) Carpal tunnel pressure is correlated with electrophysiological parameters but not the 3 month surgical outcome. J Clin Neurosci 20:272–277. https://doi.org/10.1016/j.jocn.2012.03.032 CrossRefPubMed

Choi SJ, Ahn DS (1998) Correlation of clinical history and electrodiagnostic abnormalities with outcome after surgery for carpal tunnel syndrome. Plast Reconstr Surg 102:2374–2380CrossRefPubMed

Claes F, Kasius KM, Meulstee J, Grotenhuis JA, Verhagen WI (2014) Treatment outcome in carpal tunnel syndrome: does distribution of sensory symptoms matter? J Neurol Sci 344:143–148. https://doi.org/10.1016/j.jns.2014.06.044 CrossRefPubMed

Claes F, Kasius KM, Meulstee J, Verhagen WI (2013) Comparing a new ultrasound approach with electrodiagnostic studies to confirm clinically defined carpal tunnel syndrome: a prospective, blinded study. Am J Phys Med Rehabil 92:1005–1011. https://doi.org/10.1097/PHM.0b013e31829b4bd8 CrossRefPubMed

Claes F, Meulstee J, Claessen-Oude Luttikhuis TT, Huygen PL, Verhagen WI (2010) Usefulness of additional measurements of the median nerve with ultrasonography. Neurol Sci 31:721–725. https://doi.org/10.1007/s10072-010-0258-9 CrossRefPubMed

Concannon MJ, Gainor B, Petroski GF, Puckett CL (1997) The predictive value of electrodiagnostic studies in carpal tunnel syndrome. Plast Reconstr Surg 100:1452–1458CrossRefPubMed

10.

Conzen C, Conzen M, Rubsamen N, Mikolajczyk R (2016) Predictors of the patient-centered outcomes of surgical carpal tunnel release - a prospective cohort study. BMC Musculoskelet Disord 17:190. https://doi.org/10.1186/s12891-016-1046-3 CrossRefPubMedPubMedCentral

11.

De Kleermaeker F, Meulstee J, Claes F, Kasius KM, Verhagen WIM (2017) Treatment outcome in patients with clinically defined carpal tunnel syndrome but normal electrodiagnostic test results: a randomized controlled trial. J Neurol 264:2394–2400. https://doi.org/10.1007/s00415-017-8637-2 CrossRefPubMed

12.

Katz JN, Fossel KK, Simmons BP, Swartz RA, Fossel AH, Koris MJ (1995) Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg [Am] 20:549–555. https://doi.org/10.1016/S0363-5023(05)80265-5 CrossRef

13.

Kronlage SC, Menendez ME (2015) The benefit of carpal tunnel release in patients with electrophysiologically moderate and severe disease. J Hand Surg [Am] 40(438–444):e431. https://doi.org/10.1016/j.jhsa.2014.12.012 CrossRef

14.

Kulick MI, Gordillo G, Javidi T, Kilgore ES Jr, Newmayer WL 3rd (1986) Long-term analysis of patients having surgical treatment for carpal tunnel syndrome. J Hand Surg [Am] 11:59–66CrossRef

15.

Leit ME, Weiser RW, Tomaino MM (2004) Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longitudinal assessment in patients older than age 70. J Hand Surg [Am] 29:379–383. https://doi.org/10.1016/j.jhsa.2004.02.003 CrossRef

16.

Longstaff L, Milner RH, O'Sullivan S, Fawcett P (2001) Carpal tunnel syndrome: the correlation between outcome, symptoms and nerve conduction study findings. J Hand Surg (Br) 26:475–480. https://doi.org/10.1054/jhsb.2001.0616 CrossRef

17.

Louie D, Earp B, Blazar P (2012) Long-term outcomes of carpal tunnel release: a critical review of the literature. Hand (N Y) 7:242–246. https://doi.org/10.1007/s11552-012-9429-x CrossRef

18.

Louie DL, Earp BE, Collins JE, Losina E, Katz JN, Black EM, Simmons BP, Blazar PE (2013) Outcomes of open carpal tunnel release at a minimum of ten years. J Bone Joint Surg Am 95:1067–1073. https://doi.org/10.2106/JBJS.L.00903 CrossRefPubMedPubMedCentral

19.

Luchetti R, Schoenhuber R, Alfarano M, Montagna G, Pederzini L, Soragni O (1991) Neurophysiological assessment of the early phases of carpal tunnel syndrome with the inching technique before and during operation. J Hand Surg (Br) 16:415–419CrossRef

20.

Means KR Jr, Dubin NH, Patel KM, Pletka JD (2014) Long-term outcomes following single-portal endoscopic carpal tunnel release. Hand (N Y) 9:384–388. https://doi.org/10.1007/s11552-014-9614-1 CrossRef

21.

Mondelli M, Reale F, Padua R, Aprile I, Padua L (2001) Clinical and neurophysiological outcome of surgery in extreme carpal tunnel syndrome. Clin Neurophysiol 112:1237–1242CrossRefPubMed

22.

Mondelli M, Reale F, Sicurelli F, Padua L (2000) Relationship between the self-administered Boston questionnaire and electrophysiological findings in follow-up of surgically-treated carpal tunnel syndrome. J Hand Surg (Br) 25:128–134. https://doi.org/10.1054/jhsb.2000.0361 CrossRef

23.

Nancollas MP, Peimer CA, Wheeler DR, Sherwin FS (1995) Long-term results of carpal tunnel release. J Hand Surg (Br) 20:470–474CrossRef

24.

Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD (2016) Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 15:1273–1284. https://doi.org/10.1016/S1474-4422(16)30231-9 CrossRefPubMed

25.

Schrijver HM, Gerritsen AA, Strijers RL, Uitdehaag BM, Scholten RJ, de Vet HC, Bouter LM (2005) Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol 22:216–221PubMed

26.

Soltani AM, Allan BJ, Best MJ, Mir HS, Panthaki ZJ (2014) Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity. Ann Plast Surg 72:572–578. https://doi.org/10.1097/SAP.0b013e3182956475 CrossRefPubMed

27.

Tang CQY, Lai SWH, Tay SC (2017) Long-term outcome of carpal tunnel release surgery in patients with severe carpal tunnel syndrome. Bone Joint J 99-B:1348–1353. https://doi.org/10.1302/0301-620X.99B10.BJJ-2016-0587.R2 CrossRefPubMed

28.

Visser LH, Smidt MH, Lee ML (2008) High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 79:63–67. https://doi.org/10.1136/jnnp.2007.115337 CrossRefPubMed

29.

Witt JC, Hentz JG, Stevens JC (2004) Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 29:515–522. https://doi.org/10.1002/mus.20019 CrossRefPubMed

Title: Long-term outcome after carpal tunnel release and identification of prognostic factors
Authors: Floriaan G. C. M. De Kleermaeker
Jan Meulstee
Ronald H. M. A. Bartels
Wim I. M. Verhagen
Publication date: 01-04-2019
Publisher: Springer Vienna
Keywords: Neurological Tests
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Published in: Acta Neurochirurgica / Issue 4/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-03839-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Long-term outcome after carpal tunnel release and identification of prognostic factors

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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