Should Older Adults Have Carpal Tunnel Release Surgery?Older adults (65 years old and older) seem to have a greater chance of developing carpal tunnel syndrome and with more severe symptoms. There is plenty of research evidence to support the benefits of surgery to release the soft tissues around the affected (median) nerve in the general adult population. But no one has really studied the results of surgical release in the older adult group.
This study looked at the surgical results for 78 adults (ages 65 to 93) who had carpal tunnel surgery. Each individual was carefully evaluated before surgery to make sure the diagnosis was correct. The most reliable test for carpal tunnel syndrome is a nerve conduction study. Only patients whose carpal tunnel syndrome was confirmed with nerve conduction studies were included. The surgery done was an endoscopic (minimally invasive) carpal tunnel release.
Patient charts were reviewed, data collected, and statistics analyzed. The kinds of information viewed included demographic data (e.g., age, gender, smoking status, health status, previous surgeries), clinical presentation (e.g., symptoms and physical findings), and patient satisfaction (e.g., very satisfied, satisfied, neutral, dissatisfied). Each patient filled out several surveys (questionnaires) answering questions about pain, numbness, sleep, and daily function.
Before surgery, two-thirds of the group reported constant numbness as the primary symptom. Numbness is the most typical symptom associated with carpal tunnel syndrome. True pain may be present in a small percentage of sufferers but in many cases, the numbness is so severe that it is interpreted as pain. Many of the patients were treated conservatively (splinting, steroid injection) before trying surgery. They were able to get some relief from their symptoms but not enough to avoid surgery.
Those patients who did report "pain" before surgery (70 of the 78) were able to get relief from their pain following the carpal tunnel release procedure. Almost everyone (94 per cent) who had numbness before surgery (especially noticeable at night) was no longer bothered by this symptom.
In terms of the level of satisfaction, three-fourths of the group was satisfied or very satisfied. About 10 per cent classified themselves in the middle (not satisfied and not dissatisfied) -- more neutral. About 12 per cent indicated that they were dissatisfied. Overall, the procedure was considered a success in older adults and (older) age was not a factor linked with results.
The findings of this study are very encouraging for older adults affected by carpal tunnel syndrome. Surgery to release the soft tissues around the affected nerve can be done endoscopically (small incision). The advantages to the older adult of endoscopic carpal tunnel release for carpal tunnel syndrome are many: less pain after the surgery, regain function faster, improve grip and pinch strength more quickly than with open incision surgery.
The two disadvantages of endoscopic release are: 1) possibility of nicking the nerves and blood vessels in the carpal tunnel and 2) the potential for an incomplete release. Given the severity of symptoms in the older adult and the few complications reported in this study, surgeons may be more likely to recommend this procedure now for patients 65 and older.
The authors also make note of the fact that other studies have come to the opposite conclusion (i.e., finding that older age is a predictor of poor outcomes). However, the other studies often did not follow patients past 60 days. In this study, patients were re-evaluated six months after surgery. Some of the results seem to even out with more time. They suggest that studies of open incision versus closed (endoscopic) procedures for this age group should be done to compare results and over a longer period of time (up to two years).
John D. Beck, MD, et al. Clinical Outcomes of Endoscopic Carpal Tunnel Release in Patients 65 and Over. In The Journal of Hand Surgery. August 2013. Vol. 38A. No. 8. Pp. 1524-1529.
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