Carpal tunnel release confers long-term benefits in carpal tunnel syndrome
Carpal tunnel release (CTR) has persisting long-term benefits for carpal tunnel syndrome (CTS) patients, particularly in resolving numbness, according to a study from Singapore.
“Our study agrees with existing literature and finds that the long-term outcome of CTR is favourable with a rate of recurrence of 2.5 [percent] and a rate of persistence of 3.75 [percent],” said researchers.
Investigators recruited 40 patients (mean age 55.1±10.8 years; 34 females) with severe bilateral CTS who received CTR at the Singapore General Hospital. Study outcomes were resolution of numbness, satisfaction and Boston Carpal Tunnel Questionnaire (BCTQ) scores.
Patients who had different techniques used for the two hands or who had undergone further procedures in the same limb were excluded.
Over a mean follow-up of 11.3 months, 76.3 percent (n=61) of the 80 operated hands showed complete numbness resolution while 23.8 percent (n=19) showed incomplete resolution. Two of the 61 completely resolved hands experienced numbness recurrence after the mean long-term follow-up of 9.3±2.9 years, resulting in an overall recurrence rate of 2.5 percent. [Bone Joint J 2017;99-B:1349-1353]
In contrast, 16 of 19 hands with incompletely resolved numbness experienced complete resolution after the long-term follow-up; three hands showed persistent numbness, yielding an overall persistence rate of 3.8 percent.
At the long-term follow-up, 93.8 percent of the hands had complete resolution of numbness.
This finding, according to the researchers, corroborate the suggestions of previous studies, “which have reported a considerable reduction in symptoms after CTR, even in severe cases, despite the suggestion that CTR for severe CTS might not give a satisfactory result because of irreversible damage to the median nerve.” [Neurol Med Chir 2008;48:554-559; J Hand Surg Am 2015;40:438-441; J Hand Surg Br 2001;26:481-483]
The mean Boston symptom and function scores were 1.1±0.3 and 1.15±0.46, respectively, with at least one symptom or function rated >2 in at least 15 percent of the operated hands. In contrast, 72.5 percent (n=58) of the hands scored one, indicating no symptoms or functional impairment.
Boston symptom scores were positively and significantly associated with Boston function scores (r=0.414; p<0.001).
In terms of satisfaction, 92.5 percent of patients reported being either satisfied or very satisfied with CTR; 85 percent would undergo the operation again if offered the choice, while 87.5 percent would recommend CTR to family and friends.
In comparing the techniques used, significantly more patients who received endoscopic CTR (ECTR) reported complete numbness resolution than those who underwent open CTR (OCTR; 100 vs 89.1 percent; p=0.047).
“The low rate of recurrence and BCTQ scores combined with a high level of patient satisfaction suggests that CTR gives favourable long-term outcome to patients with bilateral severe CTS,” said researchers.
“Our study also suggests that ECTR produces better patient-reported resolution of numbness at long-term follow-up than OCTR,” they added.