Neurological Outcome of Carpal Tunnel Decompression in Carpal Tunnel Syndrome

Authors

  • Ijaz Hussain Wadd Department of Neurosurgery, LGH, Lahore
  • AIN ULLAH KHAN Department of Neurosurgery, PGMI / AMC / Lahore General Hospital, Lahore
  • ABDULLAH HAROON Department of Neurosurgery, PGMI / AMC / Lahore General Hospital, Lahore
  • Anjum Habib Vohra Department of Neurosurgery, PGMI / AMC / Lahore General Hospital, Lahore

Keywords:

Carpal tunnel syndrome, Outcomes, day care surgery, Physical therapy

Abstract

Objective: To evaluate the outcome of carpal tunnel decompression in Carpal tunnel syndrome. Study Design: Prospective and retrospective observational study. Materials and Methods: This study was conducted at the Department of Neurosurgery, PGMI / AMC / Lahore General Hospital, Lahore, during the period of 4 years from Jan. 2009 to Jan. 2013. All patients with symptoms and signs of carpal tunnel syndrome and with positive nerve conduction study were included in our study. Exclusion criteria was those unfit for surgery such as patients on warfarin and patient with mild symptoms treated with wrist splint and oral analgesic, diabetic, hypothyroid patient, patients in which nerve conduction study points to radiculopathy and patients with history of trauma with carpal bone fracture were excluded from study. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated. Baseline and one – year follow-up data were analysed for 57 patients (62 hands). Results: A total of 57 patients (62 hands) treated with surgery between Jan 2009 and Jan 2013 agreed to participate in the study. Complete data at baseline and 1 year were available for 57 patients (62 hands). There was significant improvement in all domains of the Boston Carpal Tunnel and Michigan Hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. Eight patients (14%) requested advice on scar management or had queries regarding the duration of post-operative recovery of sensation and function. The total mean operating time was 12.8 minutes (range: 5–15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1–11 minutes). Patient satisfaction as judged using a Picker questionnaire was very high. Conclusions: A highly efficient clinical service involving both diagnostics and treatment can be delivered through minimum hospital visit and day care surgery while maintaining optimal outcomes and high patient satisfaction.

References

1. Atroshi I, Gummesson C, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999; 282: 153–158. 2. Chung KC. Commentary: severe carpal tunnel synd-rome. J Hand Surg Am. 2003; 28: 645–646. 3. Department of Health. The Musculoskeletal Services Framework. London: DH; 2006: p. 41. 4. Atroshi I, Gummesson C, et al. Severe carpal tunnel syndrome potentially needing surgical treatment in a general population. J Hand Surg Am. 2003; 28: 639–644. 5. US Department of Labor. Lost-work-time Injuries and Illnesses: Characteristics and Resulting Days Away From Work, 2001. Washington DC: Bureau of Labour Statistics; 2003. 6. Korthals-de Bos IB, Gerritsen AA, et al. Surgery is more cost – effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial. BMC Musculoskelet Disord. 2006; 7: 86. 7. Jarvik JG, Comstock BA, et al. Surgery versus non-sur-gical therapy for carpal tunnel syndrome: a randomised parallel – group trial. Lancet, 2009; 374: 1, 074–1, 081. 8. Jarrett ME, Giddins GE. Direct access carpal tunnel surgery. J Bone Joint Surg Br. 2003; 85: 869–870. 9. Newey M, Clarke M, et al. Nurse – led management of carpal tunnel syndrome: an audit of outcomes and impact on waiting times. Ann R Coll Surg Engl. 2006; 88: 399–401. 10. Reid MJ, David LA, Nicholl JE. A one – stop carpal tunnel clinic. Ann R Coll Surg Engl. 2009; 91: 301–304. 11. Department of Health. Transforming Clinical Neuro-physiology Diagnostic Services to Deliver 18 Weeks. London: DH; 2007. 12. Kong X, Gozani SN, Hayes MT, Weinberg DH. NC-stat sensory nerve conduction studies in the median and ulnar nerves of symptomatic patients. Clin Neurophy-siol. 2006; 117: 405–413. 13. Leite JC, Jerosch – Herold C, Song F. A systematic re-view of the psychometric properties of the Boston Car-pal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006; 7: 78. 14. Levine DW, Simmons BP, et al. A self – administered questionnaire for the assessment of severity of symp-toms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993; 75: 1, 585–1, 592. 15. Kotsis SV, Chung KC. Responsiveness of the Michigan Hand Outcomes Questionnaire and the Disabilities of the Arm, Shoulder and Hand questionnaire in carpal tunnel surgery. J Hand Surg Am. 2005; 30: 81–86.
16. Geere J, Chester R, Kale S, Jerosch – Herold C. Power grip, pinch grip, manual muscle testing or thenar atro-phy – which should be assessed as a motor outcome after carpal tunnel decompression? A systematic re-view. BMC Musculoskelet Disord. 2007; 8: 114. 17. Jerosch – Herold C. Assessment of sensibility after ner-ve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests. J Hand Surg Br. 2005; 30: 252–264. 18. Atroshi I, Larsson GU, et al. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised con-trolled trial. BMJ. 2006; 332: 1, 473. 19. Astifidis RP, Koczan BJ, et al. Patient satisfaction with carpal tunnel surgery: self – administered question-naires versus physical testing. Hand Therapy. 2009; 14: 39–45. 20. Hobby JL, Venkatesh R, Motkur P. The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome. J Hand Surg Br. 2005; 30: 599–604. 21. Mallick A, Clarke M, Kershaw CJ. Comparing the out-come of a carpal tunnel decompression at 2 weeks and 6 months. J Hand Surg Am. 2007; 32: 1, 154–1, 158. 22. Atroshi I, Hofer M, et al. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am. 2009; 34: 266–272.
23. Chatterjee JS, Price PE. Comparative responsiveness of the Michigan Hand Outcomes Questionnaire and the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Am. 2009; 34: 273–280. 24. Greenslade JR, Mehta RL, Belward P, Warwick DJ. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire? J Hand Surg Br. 2004; 29: 159–164. 25. Farmer JE, Davis TR. Carpal tunnel syndrome: a case-control study evaluating its relationship with body mass index and hand and wrist measurements. J Hand Surg Eur Vol. 2008; 33: 445–448. 26. NHS Institute for Innovation and Improvement. Impro-ving Quality and Efficiency in the Operating Theatre. Coventry: NHS; 2009. 27. NHS Institute for Innovation and Improvement. Quality and Service Improvement Tools: Reduce Things That Do Not Add Value to Patients. Coventry: NHS; 2008. 28. Leffler CT, Gozani SN, Cros D. Median neuropathy at the wrist: diagnostic utility of clinical findings and an automated electrodiagnostic device. J Occup Environ Med. 2000; 42: 398–409.
29. Shauver MJ, Chung KC. The minimal clinically impor-tant difference of the Michigan hand outcomes ques-tionnaire. J Hand Surg Am. 2009; 34: 509–514.

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Published

2014-06-30

Issue

Vol. 18 No. 1 (2014): January-June

Section

Original Articles

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The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).