Functional Status of Patients Subjected to Surgery for Carpal Tunnel Syndrome

Abstract

Objective: Describe functional status of patients who underwent surgery for carpal tunnel syndrome (CTS) in an orthopedic public hospital. Materials and Methods: Descriptive, cross-sectional, nonexperimental study. Study group consisted of patients who underwent surgery for CTS between May 2014 and May 2015 in a public hospital of Santiago, Chile. All patients were treated with open retinaculotomy and followed the same rehabilitation protocol. Exclusion criteria include psychiatric disorders, substance abuse, acute or recurrent CTS, other neurological diseases, and people who refuse to participate in the study. Study group (N = 85) was contacted by phone and scheduled for an assessment appointment. All participants signed informed consent approved by hospital’s Ethics Committee prior to evaluation. Data collection process meant no risk to participants. The following measurements were performed: application of Levine score, grip strength (GS), lateral pinch (LP) and three-digit pinch (TDP) strength, thumb opposition (TO) (Kapandji), thumb radial abduction (TRA), and thumb palmar abduction (TPA) range of motion (ROM). Outcomes are time diagnosis—surgery, time surgery—assessment, number of therapy sessions, return to activities of daily life, ROM for TO, TRA and TPA, GS, LP and TDP strength, and Levine score. Data were tabulated and analyzed with SPSS v23.0 software; descriptive analysis was conducted. Results: Thirty-six of 85 patients were eligible and contacted by phone, 26 were scheduled for assessment appointment, and 17 completed the evaluation during February to March 2016; 94.1% were women, average age of 51.0 (standard deviation [SD] = 7.15) years old and right-handed. Mean age at the time of the diagnosis was 48.08 (SD = 7.83) years old; people had to wait 18.75 (SD = 19.45) months average for surgery. None of the participants reported complications (infection, dehiscence, recurrence, pillar pain, other); 82.5% returned to their main activity (work or study). All participants underwent at least 10 sessions of physiotherapy. All parameters distributed normally (Shapiro-Wilk test). When comparing the mean of ROM for TO (Operated Right Hand [ORH] p = 1.000; Operated Left Hand [OLH] p = 0.583), TRA ([ORH] p = 0.423; [OLH] p=0.0.367), TPA ([ORH] p = 1.000; [OLH] p = 0.949), GS ([ORH] p = 0.222; [OLH] p = 0.258), LP ([ORH] p = 0.300; [OLH] p = 0.165) and TDP strength ([ORH] p = 0.192; [OLH] p = 0.005) between operated (right or left) and contralateral hand, operated hand had lower mean for all aforementioned parameters with no statistic significance, except for TDP strength when left hand was operated. Participants operated on their dominant hand have higher Levine scores for the Symptom Severity Scale (SSS) ( P = .339) and the Functional Status Scale (FSS) ( P = .819) with no statistic significance. Conclusion: No statistic difference was found at 16 months of follow-up, reflecting no significant differences for assessed parameters when comparing the operated hand and contralateral hand. Higher Levine scores for FSS and SSS show that symptoms and functional status are affected by the condition, reflecting that patients who underwent surgery on their dominant hand are in theory more affected, with no statistic difference. Surgical technique and rehabilitation protocol used seem to be safe and efficient considering the absence of complications and the obtained functional results. The main limitation of this study is the size of the patients group; more participants need to be assessed to get more conclusive data.