Electrophysiological and functional outcome after carpal tunnel release in patients with carpal tunnel syndrome: A prospective evaluation

Abstract

Background: The Carpal tunnel syndrome (CTS) is median nerve entrapment neuropathy at wrist and is one of the commonly diagnosed disabling condition of the upper extremity. The only scientifically established disease modifying treatment is carpal tunnel release (CTR). Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after release. Material and Methods: Two year Prospective Study conducted in Tata Main Hospital, Jamshedpur on 33 cases of carpal tunnel syndrome. All patients underwent open carpel tunnel release. Electrophysiological and functional outcome was assessed using Nerve Conduction Study (NCS) and Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at 1 month, 3 months and 6 months postoperatively. Results: The CTS was most common in age group 40-50 years. Females were more affected with the ratio of 7:1. Mean BCTQ score preoperatively was 2.9. Post-operative at 1 month it showed marked improvement in mean score to 1.83. At 3 and 6 month follow up it reduced to 1.58 and 1.51 respectively. NCS were assessed using mean values of Nerve sensory latency (NSL), Nerve Motor Latency (NML), Nerve Sensory Velocity (NSV), and Nerve Motor Velocity (NMV). Preoperative evaluation shows higher latency (NSL 5.23±0.88, NML 5.23±0.63) and lower velocity (NSV 30.12±3.09, NMV 30.28±4.30). Both of which improved following CTR with mean NSL 4.46±0.59, NML 4.72±0.47, NSV 39.55±1.93, and NMV 36.55±5.32 at 1 month. Further follow up at 3 and 6 month also showed significant improvement. Conclusions: Boston Carpal Tunnel Questionnaire is good tool to evaluate functional outcome after carpal tunnel release. Nerve Conduction Studies serve as a valuable tool to assess follow up as it can provide reassurance to the patient that their operation is successful and that there is further potential for clinical improvement.