Improvement in Patient-Specific Outcomes After Carpal Tunnel Release in Patients Older Than 80 Years

Abstract

Outcomes after carpal tunnel release (CTR) may be influenced by age, disease chronicity, and disease severity. Multiple studies report mixed results between age and improvement through a validated instrument, the Brigham and Women's Carpal Tunnel Questionnaire (BWQ). However, these investigations did not control for confounders and had small cohorts of younger patients. We hypothesized that patients older than 80 years have statistically significant improvement in symptom severity and functional status after CTR. Patients completed the BWQ preoperatively and postoperatively. The main outcome measurement was difference in average BWQ scores, verified with Wilcoxon signed rank test. A standardized response mean was used to calculate effect size. Covariates were based on potential confounders, such as body mass index, hypothyroidism, American Society of Anesthesiologists (ASA) status, and thenar electromyography findings. The t test or χ test was used for univariate analysis. Logistical regression predicted odds of large versus small improvement in BWQ scores in a multivariate model, which was assessed with receiver operating characteristic and Hosmer-Lemeshow tests. Statistically significant improvement was seen among the 44 patients who completed the BWQ, with symptom severity scores of 2.97 points; functional status scores, 1.52 points; and combined scores, 2.51 points. Age did not predict effect size; however, ASA status had a statistically significant inverse relation, with a decrease in the odds of large improvement by 77%. Age did not predict improvement in BWQ scores in a regression model analysis in 1 of the largest cohorts of patients older than 80 years who underwent CTR. Patients of this age do benefit from CTR. Although age is not associated with the size of this benefit, ASA status is associated, suggestive that other medical comorbidities adversely affect outcomes after CTR in this elderly population.

Clinical Results of Ultrasound‐Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician

“…It consists of an 11‐item symptom severity (BCTQ‐SS) section that ranges from 1 (normal) to 5 (very serious) and an 8‐item functional status (BCTQ‐FS) section that ranges from 1 (no difficulty) to 5 (cannot perform activity). Scores are usually reported as averages for BCTQ‐SS and BCTQ‐FS scales …”

“…Scores are usually reported as averages for BCTQ-SS and BCTQ-FS scales. 9,[39][40][41][42][43] To further assess patient outcomes, global satisfaction as assessed by a 5-point scale (1, very dissatisfied; to 5, very satisfied) was collected at all postoperative time points.…”

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

“…It consists of an 11‐item symptom severity scale (BCTQ‐SS) with each item graded from 1 (mildest) to 5 (most severe) and an 8‐item functional status scale (BCTQ‐FS) with each item graded from 1 (no difficulty with activity) to 5 (cannot perform activity at all). The responses of a patient are averaged to produce a BCTQ‐SS score and a BCTQ‐FS score . For patients treated with bilateral simultaneous releases, although the median nerve CSA measurements of both wrists were included, each patient completed only a single set of BCTQ questionnaires based on their overall clinical status.…”

“…The responses of a patient are averaged to produce a BCTQ-SS score and a BCTQ-FS score. [36][37][38][39][40][41] For patients treated with bilateral simultaneous releases, although the median nerve CSA measurements of both wrists were included, each patient completed only a single set of BCTQ questionnaires based on their overall clinical status.…”