The Effect of Age and Gender upon Symptoms and Surgical Outcomes in Carpal Tunnel Syndrome

Abstract

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.

High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome

“…2 However, some investigators have reported that older patients can have a less satisfactory outcome after surgery, 3 though this impression is not universally shared. 4,5 To the author's knowledge, no objective explanation has been suggested for these observations. As the symptoms for carpal tunnel syndrome include wrist pain, paresthesia and weakness in grip strengths, a number of medical conditions can produce a similar clinical picture; therefore, as standard practice, our department investigates these patients with neurophysiology before a surgical treatment strategy is considered if conservative treatment is unsatisfactory.…”

Patient satisfaction following carpal-tunnel decompression: a comparison of patients with and without osteoarthritis of the wrist

“…But there are a number of factors associated with poor outcome and patient satisfaction following carpal-tunnel decompression. These factors include diabetes, high age, double crush syndrome, and severity of preoperative symptoms [2,[4][5][6][11][12][13]. General factors associated with poor satisfaction are alcohol abuse, poor mental-health status and involvement of a lawyer [3,7].…”

“…There are several factors that are known to influence the outcome of the surgery. These factors include age, duration of symptoms, alcohol use, mental-health status, and presence of objective neurological deficit [2,[4][5][6][7][11][12][13].…”

Treating Carpal Tunnel Syndrome in the Elderly: Too little Too Late?

“…Guidelines suggest initially trialling wrist splints, but surgical decompression is often considered for patients with insufficient symptom relief [1]. There are divided opinions regarding the impact of age on the efficacy of surgical decompression [2,3], but increasing evidence is mounting that older patients may have a less satisfactory outcome, though may still benefit from a release [4,5]. At the time of initial publishing, the article by Povlsen 'High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome' [6] was, to our knowledge, the first to suggest an explanation based on human patient data.…”

“…It must be noted that there is certainly still evidence of benefit for surgical decompression in elderly patients with carpal tunnel syndrome [2][3][4][5]. However, the findings that the extent of nerve damage in these patients may be more extensive, as shown by the nerve conduction study findings, suggest that additional caution may be needed in the risk-benefit analysis when considering surgery in these individuals [10].…”