The influence of age on outcome after operation for the carpal tunnel syndrome

Porter, Paul B.; Venkateswaran, Balachandran; Stephenson, Hugh E.; Wray, C. C.

doi:10.1302/0301-620x.84b5.0840688

Cited by 42 publications

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“…Porter et al 3 reported that carpal tunnel surgery in older patients has worse results than in younger patients and Hobby et al 5 reconfirmed that older patients were more troubled postoperatively by reduced sensation compared with younger patients. Our results would suggest that the explanation for some of the patients in the older group having less satisfactory outcomes following surgery may be found in the statistically more severely affected conduction speeds both for the motor as well as the sensory conduction.…”

Section: Discussionmentioning

confidence: 99%

“…1 For those patients who do respond satisfactorily to conservative measures, surgical decompression is often successful. 2 However, some investigators have reported that older patients can have a less satisfactory outcome after surgery, 3 though this impression is not universally shared. 4,5 To the author's knowledge, no objective explanation has been suggested for these observations.…”

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confidence: 99%

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High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome

Povlsen

2010

annals

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Ann R Coll Surg Engl 2010; 92: 403-405 403Carpal tunnel syndrome is common in the general population with approximately 1% incidence but can often be treated with simple night wrist splints.1 For those patients who do respond satisfactorily to conservative measures, surgical decompression is often successful.2 However, some investigators have reported that older patients can have a less satisfactory outcome after surgery, 3 though this impression is not universally shared. 4,5 To the author's knowledge, no objective explanation has been suggested for these observations. As the symptoms for carpal tunnel syndrome include wrist pain, paresthesia and weakness in grip strengths, a number of medical conditions can produce a similar clinical picture; therefore, as standard practice, our department investigates these patients with neurophysiology before a surgical treatment strategy is considered if conservative treatment is unsatisfactory. This is particularly relevant if the condition is bilateral.6 However, the author acknowledges that neurophysiological diagnosis prior to surgery for carpal tunnel syndrome is a controversial issue and that many surgeons operate on clinical grounds only. The aim of this paper was, therefore, to see if there was a significant difference in sensory or motor conduction speeds between a group of patients younger than 40 years and a group of patients older than 60 years who presented with bilateral carpal tunnel syndrome which was resistant to conservative treatment with night wrist splints. Patients and MethodsFrom a specialist hand surgical clinic, 10 patients below 40 years of age and 20 patients above 60 years of age with a clinical diagnosis of bilateral carpal tunnel syndrome who had not benefited from conservative treatment with night wrist splints were evaluated with nerve conduction studies. The length of the standard conservative treatment period was 3 months from the time they were first seen in the clinic until they were reviewed in the clinic and referred for pre-surgical neurophysiology confirmation if they wanted surgical release due to insufficient subjective improvements of their complaints. Patients with previous surgical treatment for carpal tunnel syndrome were excluded. Median nerves in both hands were tested across the wrist and conduction speeds were calculated for both motor and sensory nerves. The Mann-Whitney non-parametric test was used for the statistical evaluation. Carpal tunnel syndrome has been reported by some to have a less satisfactory outcome in older patients following surgery. However, this impression is not supported by other investigators but no objective explanation has been suggested for these differences. In our department, such patients are routinely treated with night wrist splints and, if this is unsatisfactory, they are investigated with nerve conduction studies prior to surgery. PATIENTS AND METHODS This paper reports the neurophysiological outcome in a young (< 40 years of age) and an older (> 60 years of age) group of patients with clinic...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome

Povlsen

2010

annals

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“…6,7) While treatment options for CTS include splinting, 8) oral glucocorticoids 9) and local steroid injections, 10) surgical decompression remains the definitive treatment for CTS. 11) Published literature has revealed a plethora of factors that influence the outcome of carpal tunnel release, amongst which include age, 12) gender, 13) severity of CTS 14) and presence of medical comorbidities. 15) Hitherto, we do not know of any study in existing published literature that examines the effect of hand dominance on the outcome of carpal tunnel release.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome

Tang

Wei

Tay

2017

J Hand Surg Asian-Pac Vol

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Background: There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. Methods: Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). Results: In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. Conclusions: Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome.

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“…But there are a number of factors associated with poor outcome and patient satisfaction following carpal-tunnel decompression. These factors include diabetes, high age, double crush syndrome, and severity of preoperative symptoms [2,[4][5][6][11][12][13]. General factors associated with poor satisfaction are alcohol abuse, poor mental-health status and involvement of a lawyer [3,7].…”

Section: Discussionmentioning

confidence: 99%

“…There are several factors that are known to influence the outcome of the surgery. These factors include age, duration of symptoms, alcohol use, mental-health status, and presence of objective neurological deficit [2,[4][5][6][7][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Patient satisfaction following carpal-tunnel decompression: a comparison of patients with and without osteoarthritis of the wrist

Joshy

Thomas

Ghosh

et al. 2006

International Orthopaedics (SICO

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The aim of this study was to assess whether surgical decompression for carpal-tunnel syndrome (CTS) in the presence of primary or secondary osteoarthritis of the wrist is associated with poorer patient satisfaction. We did a retrospective matched cohort study. Twenty-four patients who underwent surgical decompression for CTS secondary to osteoarthritis were identified by reviewing the notes and the radiographs. A control group consisted of 24 patients without osteoarthritis of the wrist who underwent carpaltunnel decompression. The control group was matched for age, sex, side, and neuro-physiological severity of the nerve compression. In the group with osteoarthritis of the wrist, 17 (71%) patients reported their symptom relief as satisfactory, and 7 (29%) reported the results as unsatisfactory. In the control group, 23 (96%) patients reported their symptom relief as satisfactory, and 1 (4%) reported the results as unsatisfactory (P=0.0325). In conclusion, patient satisfaction following surgical decompression in patients with secondary CTS due to osteoarthritis was significantly lower compared to patients without osteoarthritis of the wrist.

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The influence of age on outcome after operation for the carpal tunnel syndrome

Cited by 42 publications

References 0 publications

High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome

High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome

The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome

Patient satisfaction following carpal-tunnel decompression: a comparison of patients with and without osteoarthritis of the wrist

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