Abstract
BackgroundObjective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS). However a range of outcome measures are used and there appears to be no consensus on which measure of motor function effectively captures change. The purpose of this systematic review was to identify the methods used to assess motor function in randomized controlled trials of surgical interventions for CTS. A secondary aim was to evaluate which instruments reflect clinical change and are psychometrically robust.MethodsThe bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical interventions for CTS. Data on instruments used, methods of assessment and results of tests of motor function was extracted by two independent reviewers.ResultsTwenty-two studies were retrieved which included performance based assessments of motor function. Nineteen studies assessed power grip dynamometry, fourteen studies used both power and pinch grip dynamometry, eight used manual muscle testing and five assessed the presence or absence of thenar atrophy. Several studies used multiple tests of motor function. Two studies included both power and pinch strength and reported descriptive statistics enabling calculation of effect sizes to compare the relative responsiveness of grip and pinch strength within study samples. The study findings suggest that tip pinch is more responsive than lateral pinch or power grip up to 12 weeks following surgery for CTS.ConclusionAlthough used most frequently and known to be reliable, power and key pinch dynamometry are not the most valid or responsive tools for assessing motor outcome up to 12 weeks following surgery for CTS. Tip pinch dynamometry more specifically targets the thenar musculature and appears to be more responsive. Manual muscle testing, which in theory is most specific to the thenar musculature, may be more sensitive if assessed using a hand held dynamometer – the Rotterdam Intrinsic Handheld Myometer. However further research is needed to evaluate its reliability and responsiveness and establish the most efficient and psychometrically robust method of evaluating motor function following surgery for CTS.
Highlights
Objective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS)
The titles and abstracts of those studies retrieved were read and fulltext was obtained for those studies which met the following inclusion criteria: prospective, randomized or quasirandomized trials, the experimental or comparator intervention included surgical release, the patients had a confirmed diagnosis of carpal tunnel syndrome made through physical examination and clinical history with or without confirmatory electrophysiological testing and the outcomes were described
As MMT can more closely target intrinsic muscles affected by compression of the median nerve in the carpal tunnel, it is more precise in detecting change in motor function due to CTS
Summary
Objective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS). A range of outcome measures are used and there appears to be no consensus on which measure of motor function effectively captures change. The purpose of this systematic review was to identify the methods used to assess motor function in randomized controlled trials of surgical interventions for CTS. To evaluate the effectiveness of different surgical techniques a range of outcome measures have been used including objective assessment of motor function. Carpal tunnel syndrome presents with a range of symptoms including motor disturbance which can range from weakness of the thenar muscles innervated by the median nerve through to complete paralysis and atrophy. The importance of improved motor function as an outcome may be undisputed the questions of what parameter should be assessed and with which instrument remain unanswered
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