Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome

Abstract

-This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS) electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up). Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient) to 4 (severe) after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed) and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69%). Patient's satisfaction after surgical and non-surgical were respectively, 77.6% and 16% ("cure"), 13.6% and 52% (much improved), 5.4% and 9.3% (little improved), 2.7% and 16% (unchanged), 0.7% and 6.7% (worsed). The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value < 0.001) and was not influenced by the CTS electrophysiological severity. There was no relationship between the outcome after surgery and duration of symptomatology, age or CTS severity. Conservative benefice was more prevalent in those with shorter symptomatology and older age; the majority of conservative failure cases had mild initial CTS. We concluded the excellent surgical benefice described by patients and the absence of any predictive factors based on CTS severity, age or duration of symptomatology for outcome.KEY WORDS: carpal tunnel syndrome, median nerve, compression neuropathy, electrodiagnosis, nerve conduction.Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica RESUMO -O presente estudo tem por objetivo avaliar a terapia utilizada e o grau de satisfação dos pacientes que tiveram diagnóstico eletrofisiológico de síndrome do túnel do carpo (STC) entre 1989 e 1994 (528 casos); foram respondidas 184 cartas entre 528 enviadas (34,8%) sendo utilizadas 165. A gravidade do STC foi classificada de 0 a 4 de acordo com uma combinação de valores de latência distal sensitiva e amplitude do potencial de ação muscular composto do nervo mediano e diferença de latência sensitiva mediano/radial. As questões foram relativas a sintomatologia atual e terapêutica utilizada, cirúrgica ou conservadora. As respostas foram correlacionadas ao estudo de condução nervosa inicial, idade e tempo de sintomatologia. Os pacientes submetidos a cirurgia somaram 69% (114 casos). O benefício cirúrgico e não cirú...

Pre‐surgery disability compensation predicts long‐term disability among workers with carpal tunnel syndrome

“…However, such measures can be inaccurate and may have poor inter-rater reliability [Dale et al, 2010; Smith et al, 2010], and a lack of correlation between electro-diagnostic findings and symptoms and function has been reported [Chan et al, 2007]. Further, the relationship between electro-diagnostic findings and surgical outcomes is not straight-forward [Kouyoumdjian et al, 2003; Dennerlein et al, 2002]. Second, we did not include type of surgery (endoscopic versus open) in our analyses.…”

Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands

“…Similar to other authors, Karsidag et al 17 have reported that the most significant electrophysiological improvement occurred after surgery, but pointed out a variable percent of cases with spontaneous improvement. Kouyoumdjian et al 9 findings added some additional difficul-ties to the understanding of CTS natural history. They concluded that, in spite of cases with short duration of symptoms had a greater improvement to conservative treatment, the majority of cases that remain symptomatic to the same conservative treatment had mild median nerve conduction abnormalities.…”

Long-term outcomes of carpal tunnel release: a critical review of the literature

“…More recently, Kouyoumdjian et al [16] received responses to a retrospective, unvalidated questionnaire from 114 open carpal tunnel release patients. The average followup time was 71 months, and the response rate was 34.8 %.…”