Predictors of Dissatisfaction and Disability After Carpal Tunnel ReleaseCarpal tunnel syndrome (CTS) continues to cause pain, numbness, and weakness of the wrist, hand, and fingers for many people each year. Surgery may be needed but patients must be chosen carefully. A positive, successful result is the goal.
Research is ongoing trying to predict who will have a good surgical result. Surgeons try to spare patients surgery if it's clear that operative treatment is not likely to succeed. For example, we know that numbness doesn't go away after carpal tunnel release when there is advanced nerve damage to begin with.
And patients who have normal nerve function don't really need surgery. They can get relief from painful symptoms with conservative care. For all the rest who may be good candidates for surgery, psychologic factors must be considered.
In this study, the effect of depression on outcomes after carpal tunnel surgery is examined. Surveys were sent to 200 patients with CTS who had open release surgery with one surgeon. All patients had positive electrodiagnostic tests to confirm CTS.
Questions were asked about satisfaction, pain anxiety, depression, and coping skills. Other factors evaluated included marital status, education level, and type of job. Cases involving worker's compensation or litigation were also noted.
It turns out that depression was a predictor of decreased satisfaction after surgery. Patients who saw themselves as disabled had higher levels of depression and pain catastrophizing (thinking the worst will happen). Patients with more severe disease were more likely to be dissatisfied. They saw themselves as disabled after surgery.
The results of this study confirm that surgeons should consider the important of psychologic factors in patient satisfaction before doing carpal tunnel release. Permanent nerve damage is not changed by the operation. Patients will be disappointed and unhappy when muscle atrophy, weakness, and numbness are still present after surgery.
Many of the patients who delay seeking medical help until nerve damage is severe are also less likely to cope well and accept their limitations. The surgeon is advised to clearly explain the limitations of surgery in cases of advance nerve damage.
Santiago A. Lozano CalderÃ³n, MD, et al. Patient Satisfaction After Open Carpal Tunnel Release Correlates with Depression. In Journal of Hand Surgery. March 2008. Vol. 33A. No. 3. Pp. 303-307.
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