Clinical Outcomes of Carpal Tunnel Release in Patients 65 and Older

Abstract

Purpose: The authors of this article present a study which examines the benefits of Carpal Tunnel Release surgery in patients 65 years of age or older. A common misconception among referring physicians holds that elderly patients have a poorer recovery after peripheral nerve injury and repair than younger patients, and that nerve conduction velocities naturally decrease with age. Therefore, their attitude and reluctance to send patients to hand surgeons suggest the belief that CTR surgery is less effective in the older population. Carpal Tunnel Syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. Some studies suggest that CTS may be more prevalent and more severe in the elderly. The authors conducted a prospective study of patients 65 years of age or older who were seeking surgical release for treatment of CTS. These patients were evaluated before and after surgery to determine the benefits of the procedure for the older population. Method: Seventy-five patients and a total of 105 hands were enrolled in the study. The average age of participants was 75 years of age. Patients were evaluated prior to surgery and again at six months after surgery. Thirty-one men and 35 women completed the 6-month follow up evaluation. Ninety-four percent of the patients were right handed. Fifty-nine percent of the patients had bilateral symptoms. The median duration of symptoms was 24 months (range 2–180 months). The evaluation consisted of a detailed history of hand dominance and symptoms including paresthesias, nocturnal symptoms, and subjective weakness. The physical examination included Tinel's sign, Phalen's sign, median nerve compression test, 2-pt discrimination, grip and pinch strength measurements and thenar wasting. CHTs performed quantitative sensory testing using a pressure-sensing device (Pressure Specified Sensory Device, Sensory Measurement Services, LLC, Baltimore, MD). This allowed for standardized grip and pinch strength measurements and static 2-pt discrimination testing. The Michigan Hand Outcomes Questionnaire (MHQ) was used to assess clinical outcomes. The MHQ evaluates overall hand function, activities of daily living (ADL's), work performance, pain, aesthetics and satisfaction with hand function. It is an internally consistent and validated measurement for patients following hand surgery. Prior to surgery, patients were asked to rate paresthesias, numbness, day pain, night pain and nocturnal weakness on a scale of 1–5 (none, mild, moderate, severe, very severe). Results: After surgery, patient symptoms of paresthesias, numbness, day pain, night pain and nocturnal weakness were significantly decreased in severity with a p value of less than .0001. Sixty-three percent of patients had complete relief of all symptoms. Tinel's sign and Phalen's sign were significantly decreased after surgery. Grip strength increased slightly while pinch strength increased significantly from pre and post surgical measures (p Discussion: In recognition of the fact that CTS is common among the elderly, and that their symptoms are often more severe than in the general public, CTR should be considered a viable course of treatment for this population. This study demonstrates the benefits of surgical interventions in terms of improved physical findings and most importantly, improved clinical outcomes. Despite long duration of symptoms in this elderly population, pre-operative symptoms decreased significantly. Overall, 83% of the patients were either completely satisfied or very satisfied with their surgical outcome.