Predictive parameters of patients' relevant outcome following surgery for carpal tunnel syndrome
Johannes Bauer (Brandenburg an der Havel), Christian Ewald (Brandenburg an der Havel), Ekkehard Scholz (Brandenburg an der Havel), Anke Weber (Brandenburg an der Havel)
The most common nerve entrapment syndrome is carpal tunnel syndrome (CTS). Clinical and instrumental findings are necessary to diagnose CTS. Decompression of the median nerve is recommended when conservative treatments fail. Although surgery is most beneficial, it may not lead to a favorable outcome for some patients. Therefore, a prospective study was conducted to examine prognostic factors for outcome following decompression surgery.
102 wrists were prospectively observed. Clinical, electrophysiologic, and neuro sonographic findings and self-reported scores were compiled 2 months before and 3 months after decompression. Parameters were compared to assess general changes. Two groups were identified with good and poor outcome based on self-reported symptom severity (SSS) and functional status scores (FSS). Data were analyzed using either student's t-test or Mann-Whitney U-test. To identify predictive parameters regression analyses were performed. Significant parameters were evaluated to determine cut-off values using ROC-curves.
The follow-up revealed improved SSS and FSS. Examinations demonstrate improvement in nerve conduction and swelling of the median nerve. Multivariate regression indicated that diabetes mellitus, SSS and positive Phalen's sign were predictors of relative decrease in symptom severity. Whereas the age group and FSS have an impact on relative improvement of functional status. Logistic regression showed a good outcome for patients younger than 50 years, without diabetes mellitus and with high preoperative SSS. For a SSS of 3.2 or higher, surgery could be recommended. When considering functional status, only a high preoperative FSS predicted a good outcome. Therefore, a cut-off value of at least 2.6 is recommended.
Analyses demonstrated that decompression resulted in physiological benefits. However, the study was unable to identify multiple predictive parameters. Results indicated that patients over 50 years and those with diabetes mellitus had a higher risk of receiving inadequate benefit from surgery. However, self-reported SSS and FSS are necessary to provide professional consultations.
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