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Self-Assessment May Help Outcome After Carpal Tunnel Release

The carpal tunnel is the spot in your wrist that allows a nerve, the median nerve to pass from your forearm into your hand. When the carpal tunnel becomes inflamed or if there is something that causes the area to get smaller, it puts pressure on this nerve and this causes pain and numbness in the hand, particularly around the thumb area. This is called carpal tunnel syndrome.

Carpal tunnel syndrome is usually a repetitive stress injury that is caused by making the same motions again and again with the wrist. It has gotten much more news since the explosion of computer and mouse use, but carpal tunnel syndrome has affected many types of workers for many years. They include pastry chefs who use icing bags continuously or construction workers who using heavy vibrating machinery, like jackhammers.

If conservative treatment for carpal tunnel syndrome (non-surgical) doesn't work for a patient, the next step is usually surgery, carpal tunnel release. However, it's always better if a surgeon can determine a prognosis ahead of time, how well a patient will do after surgery. However, although many reports have been written, there haven't been any definite findings.

The authors of this article wanted to see what factors may influence a patient's prognosis, using their own assessments and comparing these with the patients' symptoms and test findings. Researchers evaluated 102 hands of 64 patients, the majority of whom were women. There were only five men in the group. The patients were between 32 and 77 years old and their carpal tunnel syndrome symptoms were present from eight months to 25 years. The follow-up on the patients ranged from 12 to 23 months.

The researchers tested the patients for sensation in the affected hands and if there is pain at night (nocturnal pain). They also performed the Phalen test, which involves pushing back the patient's hand for 60 seconds, perhaps triggering the pain, and the Tinel sign, which involves tapping along the median nerve on the wrist to see if this worsens the tingling or pain. They also checked for weakening of the muscles. The patients were then asked to complete the Boston carpal tunnel questionnaire, which asks about the severity and frequency of symptoms, as well as how it affects function of the hand. The answers ranged from one, meaning no pain or difficulty, to five, meaning severe pain or difficulty.

After the tests and questionnaires were completed, the patients underwent surgery to release the carpal tunnel and the patients wore a short-arm splint for one week after surgery.

The researchers found that the results of the Boston scores improved in all patients after one year and all patients had improvement in their wrist and hand after three months. When the researchers looked at the questionnaires completed before the surgery, they found that the average duration of symptoms was five years and 77 of the 102 cases caused nocturnal pain. These patients, as well as those who didn't feel their hands were weak and those who did not have cold intolerance all had better outcomes after surgery than all the other patients.

The authors of this article, when discussing the study's findings, pointed out that pain at night is caused by swelling of the soft tissues at night, putting pressure on the nerve. Therefore, by releasing the nerve, there should be no more pressure on the nerve, reducing the nocturnal pain. With this, the researchers predict that patients who have nocturnal pain have a better prognosis after surgery. The researchers couldn't identify a specific reason why cold intolerance would be a factor to determine if surgery would be successful, however.


Hyun Sik Gong, MD, PhD, et al. Clinical Features Influencing the Patient-Based Outcome After Carpal Tunnel Release. In The Journal of Hand Surgery. November 2008. Vol. 33. No. 9. Pp. 1512-1516.

11/20/2008

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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