Prognostic factors for response to treatment by corticosteroid injection or surgery in carpal tunnel syndrome (palms study): A prospective multicenter cohort study

Abstract

Introduction Studies of prognosis for surgery and corticosteroid injection for carpal tunnel syndrome (CTS) have considered only a limited range of explanatory variables for outcome. Methods Data were prospectively collected on patient‐reported symptoms, physical and psychological functioning, comorbidity, and quality of life at baseline and every 6 months for up to 2 years. Outcomes were patient‐rated change over a 6‐month period and symptom‐severity score at 18 months. Results In total, 754 patients with CTS completed baseline questionnaires, and 626 (83%) completed follow‐up to 18 months. Multivariable modeling identified, independent of symptom severity at outset, higher health utility, fewer comorbidities, and lower anxiety as significant predictors of better outcome from surgery. In patients treated by steroid injection, independent of symptom severity at outset, shorter duration of symptoms and having no prior injection were significant predictors of better outcome. Discussion These multivariable models of outcome may inform shared decision making about treatment for CTS. Muscle Nerve, 2019

Sickness absence after carpal tunnel release: a multicentre prospective cohort study

“…Participants were defined as having a poor outcome if they reported one or more of the following: global rating of change score of 'worse', 'unchanged' or 'slightly improved' (12 weeks after CTR) 20 ; scar symptoms described as 'unbearable', 'very troublesome' or 'fairly troublesome' (12 weeks after CTR); use of antibiotics for an incision site infection after returning to work and additional sick-leave related to the CTR after returning to work. The duration of work absence for those with/ without poor outcomes were compared using Wilcoxon rank-sum test.…”

Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis

“…19,23,24 However, the relevance of cognitive and mental health factors as prognostic indicators of recovery to CTR is controversial. 25 There is a growing literature supporting the role of modifiable cognitive and mental health factors in CTR, 14,[26][27][28][29][30][31] . However, the assessment of these factors has not been taken into account in the recent clinical practice guidelines for patients with CTS 32 when most of the patients may end up needing surgery.…”

Carpal Tunnel Syndrome Secondary to Ganglion Cyst, with Denervation of Abductor Pollicis Brevis

“…Higher health utility, less comorbidities, less anxiety, and lower symptom severity at onset are associated with favorable surgical outcomes. A shorter duration of symptoms, no prior injections, and lower severity at onset indicate better outcomes for corticosteroid injections [14].…”