Natural Course and Treatment Efficacy: One-Year Observation in Diabetic and Idiopathic Carpal Tunnel Syndrome

Abstract

Our aims were to observe the effects of rehabilitation and surgery on idiopathic and diabetic carpal tunnel syndrome (CTS) and compare them with the natural course of the disease. Forty-two patients aged 33 to 74 years with clinically diagnosed, electrophysiologically confirmed, and laboratory screened hands with CTS (46 idiopathic and 34 diabetic) were enrolled in the study. Improvement of symptom severity and functional status after treatment using the Boston questionnaire (scales), changes of nerve conduction parameters (NCPs), and correlations between NCP and Boston questionnaires were outcome measures. Follow-up periods were 3 to 5 months and 6 to 12 months. In idiopathic CTS, surgery was effective according to scales and NCP. Rehabilitation was also effective according to scales but only in the late period. Nontreatment did not improve scales at a later period. In diabetic CTS, rehabilitation was not effective according to scales. Baseline and follow-up correlations between scales and NCP were weak and limited to sensory amplitudes (baseline), sensory amplitudes-velocity, and median motor distal latency (follow-up). Regression analysis also did not reveal any associations between scales and NCP. A repeated nerve conduction study was not meaningful if the diagnosis was definite. Treatment of CTS was definitely superior to spontaneous improvements. Rehabilitation was ineffective in diabetic CTS.

Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: A two-year observational study

“…A slow progression related to metabolic control is characteristic of peripheral neuropathy, while the association with musculoskeletal diagnosis favors local factors playing a part. This suggests a mixed etiology, supporting previous conjecture that background peripheral neuropathy renders the median nerve more susceptible to compression in the carpal tunnel (Ozkul et al, 2002;Perkins et al, 2002) so that spontaneous recovery is less likely to occur (Kiylioglu et al, 2009).…”

“…However, further study is required to differentiate the contributions of peripheral neuropathy and the hand syndromes. Although the two year duration of the study was longer than a prior study (Kiylioglu et al, 2009), it was relatively short to detect longitudinal change. Thus, the magnitude of sensory change that we detected was statistically significant but of uncertain clinical importance.…”

“…Overall, management is more challenging and interventions more complex and less successful in individuals with hand syndromes and diabetes (Baumgarten, Gerlach, & Boyer, 2007;Griggs et al, 1995;Kiylioglu, Bicerol, Ozkul, & Akyol, 2009;Ozkul, Sabuncu, Kocabey, & Nazligul, 2002;Stahl, Kanter, & Karnielli, 1997). Multiple fingers can develop triggering and outcomes from corticosteroid injection are poorer (Rozental, Zurakowski, & Blazar, 2008).…”

“…Shorter duration of symptoms, younger age and avoiding aggravating activities are associated with spontaneous improvement (Padua et al, 1999). In the single study that compared the natural history of carpal tunnel syndrome in patients with and without diabetes, patients with diabetes did not show similar improvements in symptoms over the course of a year (Kiylioglu et al, 2009).…”

Impact of Diabetes on Outcomes in Hand Surgery

“…9 Several attempts have been made to modify the natural history of CTS in diabetic patients, including the use of rehabilitation and glycemic control strategies. The use of rehabilitation to alleviate symptoms and improve hand function in diabetic patients has been demonstrated to be ineffective, 10 although that study was limited by its small sample size. Nonetheless, there does appear to be a potential role for improved glycemic control in modifying factors that predispose to CTS.…”