Outcome Of Carpal Tunnel Syndrome Research Articles

TP2.5 Management and outcome of carpal tunnel syndrome

TP2.5 Management and outcome of carpal tunnel syndrome

Decompressive Surgery Was Better Than Steroid Injection for Symptomatic and Neurophysiologic Outcomes in Carpal Tunnel Syndrome

Decompressive Surgery Was Better Than Steroid Injection for Symptomatic and Neurophysiologic Outcomes in Carpal Tunnel Syndrome

The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome

There is conflicting evidence regarding the effectiveness of carpal tunnel release in older patients. This is a prospective study which evaluates the impact of age and gender upon symptoms, self-reported disability and surgical outcome in a series of 97 patients with carpal tunnel syndrome. Symptom severity, hand function and patient satisfaction were assessed using the Boston Carpal Tunnel Questionnaire and the Patient Evaluation Measure. A statistical correlation of age and gender with symptoms, hand function and surgical outcome was performed with questionnaires administered before open carpal tunnel decompression and 6 months after surgery. Women reported greater pre-operative symptoms and disability than men, but there was no gender-related difference in surgical outcome or patient satisfaction. There was no difference in surgical outcome between patients 60 and 70 years of age and younger patients. The majority of patients over the age of 70 reported an improvement in symptoms and function, but they were less satisfied with their treatment than younger patients. Some patients had problems with persistent numbness and loss of dexterity following surgery. The outcome of carpal tunnel release in terms of improvement in the symptom and functional scores is sufficient to justify surgery in the elderly, but surgical outcomes are less predictable than in younger patients and we recommend that this is explained to them when obtaining consent for surgery.

Effect of Patient Age and Symptom Duration on Subjective and Objective Outcomes of Carpal Tunnel Surgery

This study prospectively examined the relationship between patient age and symptom duration on surgical outcome of carpal tunnel syndrome. Surgical outcomes were evaluated using both subjective and objective measures and statistical analysis was performed using canonical analysis. The result revealed patient age and symptom duration have significant effects on bot subjective and objective outcomes of carpal tunnel surgery.

Axonal degeneration in association with carpal tunnel syndrome.

Median nerve entrapment in the palm to wrist segment is known as carpal tunnel syndrome (CTS). Electromyography is the best evaluation test to confirm the disease, as it shows a median reduced conduction velocity and/or conduction block; however, the usual CTS electrodiagnostic tests do not separate segmental demyelination alone from segmental demyelination plus secondary axonal degeneration. We studied 100 hands from CTS patients (classified as mild, moderate, and severe), and 50 hands from normal subjects. The median palmar sensory nerve action potential (SNAP) amplitude was measured and compared between the two groups. It would be expected that SNAP was normal if no axonal degeneration had occurred. The results showed that in mild CTS group and part of moderate CTS group SNAP amplitude was normal, whereas in severe CTS group, and part of moderate group SNAP amplitude was reduced, proving that axonal degeneration was involved. As it is well stated that axonal lesions have worse prognosis than segmental demyelinating ones, this simple test may help to preditic the CTS outcome and treatment.

Use of outcome instruments to compare workers' compensation and non-workers' compensation carpal tunnel syndrome

Validated outcome instruments were used to compare treatment outcomes of carpal tunnel syndrome (CTS) in workers' compensation and non-workers' compensation patients. A self-administered questionnaire consisting of the generic Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the disease-specific Carpal Tunnel Syndrome Instrument was mailed to 277 patients randomly selected from all 1050 new patients treated for CTS during a 1-year period. A total of 212 patients (61 workers' compensation and 151 non-workers' compensation) responded to the survey 7-22 (mean, 14) months after the initiation of treatment, yielding a response rate of 76%. Workers' compensation patients had worse mean scores than non-workers' compensation patients in 6 of the 8 SF-36 scales and in the 2 Carpal Tunnel Syndrome Instrument scales, but validating multivariate analysis could not verify significant score differences in any of the scales. Thus, this study could not demonstrate inferior treatment outcomes of CTS in workers' compensation patients as measured by standardized generic and disease-specific outcome instruments.

Patients' preferences and their relationship with satisfaction following carpal tunnel release

Patients' preferences for specific health outcomes in carpal tunnel syndrome (CTS) and their association with demographic factors and satisfaction with the results of surgery after 6 months were evaluated. Two hundred fifty subjects with CTS and enrolled in a prospective community-based cohort study in Maine completed a preference questionnaire before surgery. Patients were asked to specify the single most important reason they decided to undergo surgery and to rate the importance of improvement in 10 areas, including lessening of specific symptoms and improvement in specific functional states related to CTS. The single most important reason for CTS patients to have surgery was relief of night pain (37%), followed by relief of numbness (21%) and relief of daytime pain (13%). When patients were asked to rate the importance of obtaining relief from specific symptoms and improvement in specific functional states, relief of numbness received the highest rating, with 94% of the patients answering that it was extremely or very important. Workers' compensation recipients, patients with less than a college level of education, and patients with more severe symptoms and functional impairment at baseline assigned higher importance to symptom relief and functional improvement. Controlling for other predictors, higher preference for improved strength was associated with lower satisfaction with the results of the surgery at 6 months. Most CTS patients undergoing surgery have realistic preferences for health outcomes that are influenced by demographic and clinical characteristics; however, physicians should pay attention to unrealistic preferences that might influence patients' satisfaction with surgical results.

Clinical and employment outcomes of carpal tunnel syndrome in oregon workers’ compensation recipients

We examined demographic, occupational, and treatment characteristics in 316 Oregon workers with carpal tunnel syndrome (CTS) to identify factors associated with clinical and employment outcomes. The goal of this hypothesis-generating study was to identify factors amenable to change through return-to-work programs. Mean claim duration numbered 217 days; median duration was 194 days. Sixty-one percent of workers received timeloss pay at some point during their claim. Workers having CTS surgery numbered 196 (62%). Variables predicting greater days of timeloss in workers with surgery (n=192) included: (1) decreased ability to “get along on income,” (2) attorney involvement, (3) fewer years education, (4) having bilateral surgery, (5) having physical therapy before surgery, (6) longer claim duration, and (7) hand-intensive occupational tasks (r2=36%, adjusted r2=34%). The interplay between occupational and non-occupational factors mandates a comprehensive approach to the evaluation and treatment of workers with CTS.

Long-term symptom outcomes of carpal tunnel syndrome and its treatment

A retrospective follow-up study of a population-based case series was conducted to determine the clinical course and outcomes of carpal tunnel syndrome (CTS). A total of 425 cases first diagnosed between 1979 and 1988 were followed through 1993. Among patients who did not have surgery, median duration of symptoms was between 6 and 9 months, but 22% had symptoms for 8 years or longer. Patients who had surgery were about 6 times more likely to have resolution of their symptoms than were patients who did not have surgery. Patients who had surgery 3 or more years after their initial diagnosis of CTS were less than half as likely to have symptom resolution than were patients who had surgery within 3 years of diagnosis. The results indicate that surgery is a highly effective treatment, but duration of CTS prior to surgery is a key determinant of surgical outcome.

Vitamin B6 in Carpal Tunnel Syndrome

Vitamin B6 in Carpal Tunnel Syndrome

Functional Outcome of Carpal Tunnel Syndrome After Exercise versus Ultrasound Diathermy

Objective: to compare the effectiveness of Tendon and Nerve Gliding Technique (TNGT) exercise with ultrasound diathermy.Methods: Twenty Carpal Tunnel Syndrome (CTS) hands meet the inclusion criteria and divided into2 groups: TNGT exercise and Ultrasound group. The subjects’ characteristics in the two groups are homogenous.Results: The statistical analysis results using Friedman test on pain/paresthesia complaint and hand functional status in each group is significant. Using the ANOVA, results of pain/paresthesia complaintbetween two groups shows a significant difference in the 4th measurement and results of functional status between two groups show a significant difference in the 9th measurement.Conclusions: Our study emphasized the TNGT exercise combined with splinting will be a good alternative treatment for CTS beside ultrasound diathermy combined with splinting, since TNGTexercise group has the same effectiveness with ultrasound diathermy group in decreasing VAS and has better effectiveness in improvement of FSS.Keywords: CTS, TNGT, Ultrasound Diathermy, VAS, FSS.