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Median nerve decompression in carpal tunnel syndrome: short- and long-term results

https://doi.org/10.14412/2074-2711-2018-3-79-85

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Abstract

Objective: to investigate the short- and long-term results of surgical median nerve decompression via classical and minimally invasive approaches in patients with carpal tunnel syndrome (CTS), as well as factors that influence surgical outcomes. Patients and methods. The investigation enrolled 70 patients (13 men and 57 women) aged 36 to 84 years (mean age, 62±10.8 years) who had undergone median nerve decompression. Surgery was performed in the classical way in 35 patients (Group 1) and via a minimally invasive access in the remaining 35 patients (Group 2). The efficiency of treatment was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analog scale for pain before and 1, 3, 6, and 12 months after surgery, as well as from patient satisfaction with surgical outcomes. Results. No complications of surgical treatment were detected. There was a marked reduction in pain and other neuropathic disorders just 1 month after surgery and a substantial hand functional improvement following 6 months. After 12 months, in Group 1, the mean BCTQ Symptom Severity Scale and Functional Deficit Scale scores decreased from 2.76 to 1.15 (p≤0.01) and from 2.72 to 1.24 (p≤0.01), respectively; in Group 2, these dropped from 2.86 to 1.14 (p≤0.01) and from 2.95 to 1.24 (p≤0.01), respectively. Complete recovery from sensory problems occurred in 24 (69%) patients in Group 1 and in 25 (71%) patients in Group 2; their partial recovery was observed in 11 (31%) and 10 (29%) patients in these groups, respectively. One 1 month following decompression, the patients in Group 1 had more severe pain syndrome than those in Group 2; these differences became statistically insignificant after 6 months. The patients were found to be highly satisfied with surgical treatment. Permanent numbness, subjective weakness, thenar muscle atrophy, stage III CTS, and diabetes mellitus (DM) were predictors for less pronounced improvement in BCTQ scores after surgical treatment (p<0.05). The paper describes a clinical case that achieved full postoperative occupational and home rehabilitation. Conclusion. The patients with CTS were observed to have a marked reduction in pain and other neuropathic disorders just one month after surgical decompression and a substantial hand functional improvement following 6 months. The benefit from a minimally invasive access is less severe pain syndrome at 1 month after surgery. The predictors of less successful results of surgery are age (the older the patient is, the greater likelihood of having a worse result), permanent numbness, subjective hand weakness, thenar muscle atrophy, DM, and stage III CTS.

About the Authors

A. S. Gilveg
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine


V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine


G. Yu. Evzikov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine


References

1. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008 Jan;77(1):6-17.

2. Phalen GS. The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966 Mar;48(2):211-28.

3. Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015 Jun;29(3):440-53. doi: 10.1016/j.berh.2015.04.026. Epub 2015 May 27.

4. Atroshi I, Flondell M, Hofer M, Ranstam J. Methylprednisolone Injections for the Carpal Tunnel Syndrome: A Randomized, Placebo-Controlled Trial. Ann Intern Med. 2013 Sep 3;159(5):309-17. doi: 10.7326/0003-4819-159-5-201309030-00004.

5. Scutt N, Rolf CG, Scutt A. Glucocorticoids inhibit tenocyte proliferation and Tendon progenitor cell recruitment. J Orthop Res. 2006 Feb; 24(2):173-82.

6. Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night- only versus fulltime wear instructions. Arch Phys Med Rehabil. 2000 Apr;81(4):424-9.

7. Hal B, Lee Hoe C, Fitzgerald H, et al. Investigating the Effectiveness of Full-Time Wrist Splinting and Education in the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial. Am J Occup Ther. 2013 Jul-Aug;67(4):448-59. doi: 10.5014/ajot. 2013.006031.

8. Turner A, Kimble F, Gulyаs K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg. 2010 Jan;80(1-2):50-4. doi: 10.1111/j.1445-2197.2009.05175.x.

9. Bland JD. Treatment of carpal tunnel syndrome. Muscle Nerve. 2007 Aug;36(2):167-71.

10. Learmonth J. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am. 1933; 13:905–13

11. Atroshi I, Hofer M, Larsson GU, et al. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a rand- omized controlled trial. J Hand Surg Am. 2009 Feb;34(2):266-72. doi: 10.1016/j.jhsa. 2008.10.026.

12. Leit ME, Weiser RW, Tomaino MM. Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longi- tudinal assessment in patients older than age 70. J Hand Surg Am. 2004 May;29(3): 379-83.

13. Tomaino MM, Weiser RW. Carpal tunnel release for advanced disease in patients 70 years and older: does outcome from the pa- tient’s perspective justify surgery? J Hand Surg Br. 2001 Oct;26(5):481-3.

14. Mondelli M, Reale F, Sicurelli F, Padua L. Relationship between the self-administered Boston questionnaire and electrophysiological findings in follow-up of surgically-treated carpal tunnel syndrome. J Hand Surg Br. 2000 Apr; 25(2):128-34.

15. Kanatani T, Fujioka H, Kurosaka M, et al. Delayed electrophysiological recovery after carpal tunnel release for advanced carpal tunnel syndrome: a two-year follow-up study. J Clin Neurophysiol. 2013 Feb;30(1):95-7. doi: 10.1097/WNP.0b013e31827ed839.

16. Hobby JL, Venkatesh R, Motkur P. The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome. J Hand Surg Br. 2005 Dec;30(6):599-604. Epub 2005 Sep 6.

17. Iida J, Hirabayashi H, Nakase H, Sakaki T. Carpal tunnel syndrome: electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo). 2008 Dec;48(12):554-9.

18. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group(UECG). Am J Ind Med. 1996 Jun;29(6):602-8.

19. Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symtoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993 Nov;75(11):1585-92.

20. Louie DL, Earp BE, Collins JE, et al. Outcomes of open carpal tunnel release at a minimum of ten years. J Bone Joint Surg Am. 2013 Jun 19;95(12):1067-73. doi: 10.2106/ JBJS.L.00903.

21. Tang CQY, Lai SWH, Tay SC. Long-term outcome of carpal tunnel release surgery in patients with severe carpal tunnel syndrome. Bone Joint J. 2017 Oct;99-B(10):1348-1353. doi: 10.1302/0301-620X.99B10.BJJ-2016-0587.R2.

22. Юсупова ДГ, Супонева НА, Зимин АА и др. Валидация Бостонского опросника по оценке карпального туннельного синдрома (Boston Carpal Tunnel Questionnaire) в Рос-сии. Нервно-мышечные болезни. 2018; 8(1):38–45. [Yusupova DG, Suponeva NA, Zimin AA, et al. Validation of the Boston questionnaire on assessment of carpal tunnel syndrome (Boston Carpal Tunnel Questionnaire) in Russia. Nervno-myshechnye bolezni. 2018;8(1): 38–45. (In Russ.)].

23. Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symtoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993 Nov;75(11):1585-92.

24. Gay RE, Amadio PC, Johnson JC. Comparative responsiveness of the disabilities of the arm, shoulder, and hand, the carpal tunnel questionnaire, and the SF-36 to clinical change after carpal tunnel release. J Hand Surg Am. 2003 Mar;28(2):250-4.

25. Gerritsen AA, de Krom MC, Struijs MA, et al. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol. 2002 Mar; 249(3):272-80.

26. Hui AC, Wong S, Leung CH, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005 Jun 28;64(12):2074-8.

27. Burke FD,Wilgis EF, Dubin NH, et al. Relationship Between the Duration and Severity of Symptoms and the Outcome of Carpal Tunnel Surgery. J Hand Surg Am. 2006 Nov;31(9):1478-82.

28. Вершинин АВ, Гуща АО, Арестов СО, Низаметдинова ДМ. Метод хирургического лечения карпального туннельного синдрома с применением эндоскопического контроля и электрофизиологического мониторинга. Анналы клинической и экспериментальной неврологии. 2017;11(3):41–6. [Vershinin AV, Gushcha AO, Arestov SO, Nizametdinova DM. Method of surgical treatment of carpal tunnel syndrome using endoscopic control and electrophysiological monitoring. Annaly klinicheskoii i eksperimental'noii nevrologii. 2017;11(3):41–6. (In Russ.)].

29. Conzen C, Conzen, MA, Rü bsamen N, Mikolajczyk RT. Predictors of the patient-centered outcomes of surgical carpal tunnel release – a prospective cohort study. BMC Musculoskelet Disord. 2016 Apr 27;17:190. doi: 10.1186/s12891 -016-1046-3.

30. Aslani HR, Alizadeh K, Eajazi A, et al. Comparison of carpal tunnel release with three different techniques. Clin Neurol Neurosurg.; 2012 Sep;114(7):965-8. doi: 10.1016/j.clineuro. 2012.02.017

31. Padua L, Lo Monaco M, Padua R, et al. Carpal tunnel syndrome: neurophysiological results of surgery based on preoperative electrodiagnostic testing. J Hand Surg Br. 1997 Oct; 22(5):599-601.

32. Townshend DN, Taylor P, Gwynne-Jones DP. The outcome of carpal tunnel decompression in elderly patients. J Hand Surg Am. 2005 May;30(3):500-5.

33. Hobby JL, Venkatesh R, Motkur P. The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome. J Hand Surg Br. 2005 Dec;30(6):599-604. Epub 2005 Sep 6.

34. Celiker R, Basgoze O, Bayraktar M. Early detection of neurological involvement in diabetes mellitus. Electromyogr Clin Neurophysiol. 1996 Jan-Feb;36(1):29-35.

35. Choi SJ, Ahn DS. Correlation of clinical history and electrodiagnostic abnormalities with outcome after surgery for carpal tunnel syndrome. Plast Reconstr Surg. 1998 Dec;102(7): 2374-80.

36. Al-Qattan MM, Manktelow RT, Bowen CV. Outcome of the carpal tunnel release in diabetic patients. J Hand Surg Br. 1994 Oct;19(5):626-9.

37. Mondelli M, Reale F, Padua R, et al. Clinical and neuro- physiological outcome of surgery in extreme carpal tunnel syndrome. Clin Neurophysiol. 2001 Jul;112(7):1237-42.

38. Kronlage SC, Menendez ME. The benefit of carpal tunnel release in patients with electrophysiologically moderate and severe disease. J Hand Surg Am. 2015 Mar;40(3):438-44.e1. doi: 10.1016/j.jhsa.2014.12.012.

39. Гильвег АС, Парфенов ВА, Евзиков ГЮ. Компрессионная невропатия срединного нерва у пациентов пожилого и старческого возраста: диагноз и ошибки диагностики. Клиническая геронтология. 2017;23(7-8): 3-10. [Gil'veg AS, Parfenov VA, Evzikov GYu. Compression neuropathy of the median nerve in elderly and senile patients: diagnosis and diagnostic errors. Klinicheskaya gerontologiya. 2017;23(7-8):3-10. (In Russ.)].


For citation:


Gilveg A.S., Parfenov V.A., Evzikov G.Y. Median nerve decompression in carpal tunnel syndrome: short- and long-term results. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):79-85. (In Russ.) https://doi.org/10.14412/2074-2711-2018-3-79-85

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ISSN 2074-2711 (Print)
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