Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longitudinal assessment in patients older than age 70

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.