Pre-Operative Factors and Treatment Outcome Following Carpal Tunnel Release

Abstract

The outcome of carpal tunnel release was evaluated retrospectively in 60 hands of 53 patients followed for six to 33 months (median ten months). Outcome was considered good in 27% (pain, weakness, and numbness were essentially resolved); fair in 42% (most of the symptoms improved); and poor in 32% (symptoms persisted or worsened). Patients whose pre-operative work activity was considered physically strenuous were associated with a slightly but significantly poorer outcome (60% good or fair) compared to those in light work or with no employment (89% good or fair). Proportionately fewer patients returned to their original work when they previously engaged in strenuous activity, ranging from 27% for those using air guns to 80% in light work. It appears that the highest chance of a poor outcome from carpal tunnel release occurs in patients who have either associated symptoms of thoracic outlet syndrome or physically strenuous work activities.

Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers

“…6,36,[45][46][47][48][49][50][51][52][53][54] Because functional status is very important to the worker, it has been included in this study. For most workers, the ability to perform activities of daily living and manual recreational activities is as important as the ability to be employed and the absence of symptoms.. For these reasons we used established and validated questionnaires that assessed all 4 areas.…”

Clinical Features Influencing the Patient-Based Outcome After Carpal Tunnel Release

“…Although there are numerous reports that suggest certain preoperative clinical features as predictive factors for the outcome of carpal tunnel release, they provide rather conflicting results and are largely based on assessments by the physicians or on a totally or partially retrospective study. [1][2][3][4][5][6] Outcome measurement by a clinician can be subject to observer bias and may not reflect the patient's perspective and satisfaction. Retrospective data collection can have inaccurate recall or response shift, especially when the major variables are self-reported.…”

Predictors of outcomes of carpal tunnel release

“…Several studies have investigated the factors influencing the outcomes of carpal tunnel release. Worse outcomes of surgery have been associated with preoperative muscle weakness or atrophy (4,7,8), worker's compensation (9,10), predisposing medical conditions (4) including diabetes and thyroid disease (11), heavy or repetitive manual work (12,13), exposure to vibration (14), incorrect diagnosis (15), and incomplete sectioning of the transverse carpal ligament (15). Predictors of favorable surgical outcomes include prominence of paresthesia (rather than numbness or weakness [16]) and favorable response to corticosteroid injection (4,17).…”