Carpal Tunnel Release Effectiveness Appears to Be Maintained in SeniorsCarpal tunnel syndrome, a repetitive strain injury is increasingly common in the developed world. Each year, one million adults in the United States are diagnosed with carpal tunnel syndrome. About 200,000 surgeries each year performed to correct the problem. The syndrome occurs when the median nerve, the nerve that runs from your forearm through your wrist and into your hand, becomes compressed as it passes through the carpal tunnel, in the wrist. The compression is most often due to inflammation in the tendon, because of constant use and wear of the tendon by repetitive motions.
Although carpal tunnel syndrome is often thought of as striking people of working age, seniors also develop the problem or continue to have the problem after it developed earlier in life. In fact, seniors can be at risk for having more severe symptoms of the syndrome. Unfortunately, often, treatment for some health issues begins to come into question after a patient reaches age 65. For certain procedures, such as carpal tunnel release, there is some question as to whether it is effective and a viable treatment. The authors of this study looked into the issue.
Researchers followed up with 66 patients who had been diagnosed with carpal tunnel syndrome and who were 65 years old or older at the time of diagnosis and surgery in 2000 or 2001. Of the original 66 patients, the researchers were able to contact 54 who, among them, had 92 hands treated for carpal tunnel syndrome. Nineteen of the patients (29 hands) agreed to participate by undergoing a repeat history and physical examination, and to answer questions about their health status and use of their hand.
The researchers checked for pain and physical performance by performing Tinel's sign, Phalen's sign, medial nerve compression test, two-point discrimination, grip and pinch strength measurements and by checking to see if there was any weakening or wasting away of the thenar muscle (muscle in the thumb). They also rated symptoms on a scale of one (none) to five (very severe). The symptoms included:
- tingling, pins-and-needles sensation (parasthesia)
- day pain
- night pain
- numbness at night, while sleeping
The patients' hand performance was assessed through the Michigan Hand Outcomes Questionnaire (MHQ), which evaluates overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function in both hands. The higher the scores, the better the results. The patients had been asked to rate their satisfaction with their surgery results six months following the surgery and were again for this study, five years after. This was assessed on a scale of one to five, with one meaning dissatisfied and five being completely satisfied.
After reviewing all the test and questionnaire results, the researchers found that at this point, the participants ranged from 75 to 81 years old. All of the patients said that their carpal tunnel syndrome symptoms had decreased significantly. They had resolved completely at six months in many cases:
- 84 percent no longer experienced parasthesia after six months, 76 percent after five years
- 70 percent no longer experienced numbness after six months, 86 percent after five years
- 83 percent no longer experienced day pain after six months, 90 percent after five years
- 89 percent no longer experienced night pain after six months, 83 percent after five years
- 83 percent no longer experience numbness at night after six months, 72 percent after five years
One patient had to have repeat surgery after the six-month follow-up because the symptoms had returned.
When comparing the physical aspects, the researchers found that, overall, there was significant improvement in sensation to the hands after six months but not much between six months and five years. For strength, there was also a significant improvement at six months, but a drop between six months and five years.
Although the results of this study show that patients who were over 65 years old when they had surgery to repair carpal tunnel syndrome maintained their good results after five years, the authors of the study caution that the results may be a little skewed by the lack of participation of the others initially in the study, who refused to participate. The researchers have no way of knowing how they fared with their hand function and sensitivity, nor if they were satisfied with the surgery results.
Robert A. Weber, MD, Daniel J. DeSalvo, MD, and Malcolm J. Rude, MD. Five-Year Follow-Up of Carpal Tunnel Release in Patients Over Age 65. In Â Journal of Hand Surgery. February 2010. Vol. 35. No. 2. Pp. 207-211.
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