An analysis of patient’s and disease related factors predictive of the outcomes of surgery for carpal tunnel syndrome

2020 ◽  
Vol 52 (01) ◽  
pp. 11-17
Author(s):  
Andrzej Zyluk ◽  
Paulina Zyluk-Gadowska ◽  
Lukasz Kolodziej ◽  
Zbigniew Szlosser
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Clinical Severity ◽  
Related Factors ◽  
Minimally Clinically Important Difference ◽  
Duration Of Symptoms ◽  
Younger Age ◽  
Severity Scores ◽  
Tunnel Syndrome

Abstract Purpose Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition. Methods The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated. Results Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery. Conclusion Of all considered patient’s and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome.

A PRACTICAL ELECTROPHYSIOLOGICAL GUIDE FOR NON-SURGICAL AND SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME

2008 ◽  
Vol 33 (1) ◽  
pp. 32-37 ◽  
Author(s):  
C. -W. CHANG ◽  
Y. -C. WANG ◽  
K. -F. CHANG
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Electrophysiological Tests ◽  
Severity Scores ◽  
Functional Scores ◽  
Electrophysiological Studies ◽  
Severe Group ◽  
Tunnel Syndrome

In the present study, we illustrate the use of an electrophysiological classification as a guide to the treatment of carpal tunnel syndrome (CTS). A total of 113 CTS patients were assessed with symptom severity scores, hand functional scores and electrophysiological studies. By setting criteria of electrophysiological tests, 179 hands in 113 patients were classified into mild, moderate and severe degrees of CTS. Of these, the 41 hands with severe CTS were referred for surgery. The 58 hands with moderate CTS and 80 hands with mild CTS received conservative treatment. The improvement ratios in the severe group were greater than that in the moderate and mild groups, both at 6 months and at 1 year. Eighteen hands with moderate or mild CTS returned to normal electrophysiology with the conservative treatments. No patient recovered to normal electrophysiology in the severe group. This electrophysiological classification is objective and it may serve as a useful guide for non-surgical and surgical treatment of CTS.

scholarly journals A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery

2017 ◽  
Vol 50 (03) ◽  
pp. 260-265
Author(s):  
Sushil Ramesh Nehete ◽  
Binita B. Raut ◽  
Amita S. Hiremath ◽  
R. Mukund Thatte
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Statistical Correlation ◽  
Clinical Severity ◽  
Thenar Muscle ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
Operative Recovery ◽  
A Prospective Study

ABSTRACT Objective: We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery. Patients and Methods: A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively. Results: Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05). Conclusions: Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.

Recurrent and persistent carpal tunnel syndrome: predicting clinical outcome of revision surgery

2020 ◽  
Vol 132 (3) ◽  
pp. 847-855
Author(s):  
Pepijn O. Sun ◽  
Ruud W. Selles ◽  
Miguel C. Jansen ◽  
Harm P. Slijper ◽  
Dietmar J. O. Ulrich ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Outcome ◽  
Carpal Tunnel ◽  
Revision Surgery ◽  
Prediction Models ◽  
Total Duration ◽  
Clinical Severity ◽  
Duration Of Symptoms ◽  
Tunnel Syndrome ◽  
And Function

OBJECTIVEThe aim of this study was to evaluate the self-reported outcome of revision surgery in patients with recurrent and persistent carpal tunnel syndrome (CTS) and to identify predictors of clinical outcome of revision surgery.METHODSA total of 114 hands in 112 patients were surgically treated for recurrent and persistent CTS in one of 10 specialized hand clinics. As part of routine care, patients were asked to complete online questionnaires regarding demographic data, comorbidities, and clinical severity measures. The Boston Carpal Tunnel Questionnaire (BCTQ) was administered at intake and at 6 months postoperatively to evaluate clinical outcome. The BCTQ comprises the subscales Symptom Severity Scale (SSS) and Functional Status Scale (FSS), and the individual scores were also assessed. Using multivariable regression models, the authors identified factors predictive of the outcome as measured by the BCTQ FSS, SSS, and total score at 6 months.RESULTSRevision surgery significantly improved symptoms and function. Longer total duration of symptoms, a higher BCTQ total score at intake, and diagnosis of complex regional pain syndrome (CRPS) along with CTS were associated with worse outcome after revision surgery at 6 months postoperatively. The multivariable prediction models could explain 33%, 23%, and 30% of the variance in outcome as measured by the FSS, SSS, and BCTQ total scores, respectively, at 6 months. Although patients with higher BCTQ scores at intake have worse outcomes, they generally have the most improvement in symptoms and function.CONCLUSIONSThis study identified total duration of symptoms, BCTQ total score at intake, and diagnosis of CRPS along with CTS as predictors of clinical outcome and confirmed that revision surgery significantly improves self-reported symptoms and function in patients with recurrent and persistent CTS. Patients with more severe CTS symptoms have greater improvement in symptoms at 6 months postoperatively than patients with less severe CTS, but 80% of patients still had residual symptoms 6 months postoperatively. These results can be used to inform both patient and surgeon to manage expectations on improvement of symptoms.

scholarly journals Intralesional steroid and ultrasound therapy in patients with carpal tunnel syndrome

2019 ◽  
Vol 12 (4) ◽  
pp. 177-181
Author(s):  
Md. Israt Hasan ◽  
Syed Mozaffar Ahmed
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Naproxen Sodium ◽  
Ultrasound Therapy ◽  
Severity Scores ◽  
Intralesional Steroid ◽  
Tunnel Syndrome ◽  
Wrist Splint

The study aimed to compare the effects of intralesional steroid injection and ultrasound therapy for the treatment of carpal tunnel syndrome. A total 130 patients divided into 2 groups: a) One group (n=65) received intralesional corticosteroid injection along with wrist splint, exercise, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=65) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with  Wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks. The patients were followed-up 2 weekly for 4 weeks. The visual analogue score, symptom severity scores and functional status scores were significantly improved within each group at week 2 (p<0.05) and week 4 (p<0.05) except for the symptom severity score at (p>0.05). The improvement in symptom severity scores and functional status scores in the intralesional steroid group was more than in the ultrasound therapy group after 4 weeks.

scholarly journals Assessment of the diagnostic accuracy of nerve conduction study and the correlation between severity of symptoms and nerve conduction studies in carpal tunnel syndrome

2019 ◽  
Vol 5 (4) ◽  
pp. 559
Author(s):  
Benjamin Alex ◽  
Mithun Joy Kattoor ◽  
Samson Samuel Edayalamuriyil
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Symptom Severity ◽  
Nerve Conduction ◽  
Nerve Conduction Studies ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
Surgical Release

<p class="abstract"><strong>Background:</strong> This study was done to assess the diagnostic accuracy of nerve conduction study in carpal tunnel syndrome and comparability of nerve conduction measures before and after carpal tunnel release.</p><p class="abstract"><strong>Methods:</strong> 31 patients (30 females and 1 male) with carpal tunnel syndrome were subjected to nerve conduction study and Boston symptom severity scores before surgery and at 3 months post-operative period and nerve conduction values compared. The effect of duration of symptoms on nerve conduction values was studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Nerve conduction studies were found to be reliable in diagnosing carpal tunnel syndrome. 61.30% patients showed a right-handed involvement, or right side getting affected first in a bilateral case. 60-80% patients had Boston symptom severity scores which were comparable to the nerve conduction grades ascertaining the relationship between them. Only 58.8% patients with extreme and severe NCS grades preoperatively showed improvement post-surgical release. In patients with symptoms for more than 12 months, only 33.33% had improved nerve conduction grades post-surgical release at 3 months, validating the need for early surgical release.</p><p class="abstract"><strong>Conclusions:</strong> Nerve conduction study was found to be a reliable diagnostic modality for diagnosis of carpal tunnel syndrome and nerve conduction study values correlated with the Boston symptom severity score. The post-operative nerve conduction values revealed definite neurological improvement in patients who underwent early surgical management. Hence, we recommend early release for carpal tunnel syndrome patients for speedy recovery from the condition.</p>

scholarly journals Clinical Utility of the 6-Item CTS, Boston-CTS, and Hand-Diagram for Carpal Tunnel Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Gregor Schulze ◽  
Kristian Bernhard Nilsen ◽  
Rikke Munk Killingmo ◽  
John Anker Zwart ◽  
Margreth Grotle
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Construct Validity ◽  
Internal Consistency ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Clinical Utility ◽  
Severity Assessment ◽  
Discriminative Ability ◽  
Tunnel Syndrome ◽  
Severity Levels

Background: Self-reported measures are often used in research and clinical practice to diagnose carpal tunnel syndrome (CTS) and guide therapeutic choices. We aimed to assess the clinical utility of the Norwegian versions of two self-reported outcome measures for symptom severity assessment, the 6-item CTS (CTS-6), and Boston-CTS (BCTQ), and of one diagnostic measure, the hand-diagram, by evaluating measurement properties including discriminative ability for severity assessment (CTS-6, BCTQ), and diagnosis of CTS (hand-diagram).Methods: We performed forward and backward translation and cultural adaptation of the Norwegian CTS-6 and BCTQ. Following COSMIN guidelines, we investigated internal consistency, reliability, construct validity, and discriminative ability for distinguishing between severity levels of CTS in patients with confirmed CTS for the CTS-6 and BCTQ and reliability and discriminative ability for diagnosing CTS for the hand-diagram.Results: Two hundred and fifty-one patients referred for diagnostic work-up for CTS with nerve conduction studies (NCS) participated. The CTS-6 and BCTQ had acceptable internal consistency (Crohnbach's α = 0.82 and 0.86, respectively), reliability (ICC = 0.86 and 0.90; SEM = 0.24 and 0.20; SDC95% = 0.68 and 0.55, respectively), construct validity (all eight pre-defined hypotheses confirmed) and discriminative ability to distinguish between severity levels of CTS [Area under the curve (AUC) = 0.75, 95% CI 0.64–0.85]. The hand-diagram had acceptable reliability (Cohen's kappa = 0.69) and discriminative ability to diagnose CTS (sensitivity = 0.72, specificity = 0.90).Conclusion: Our findings support the clinical utility of the CTS-6 and BCTQ for symptom severity assessment and of the hand-diagram for diagnostic screening.

Psychological Status Is Associated With Symptom Severity in Patients With Carpal Tunnel Syndrome

2018 ◽  
Vol 43 (5) ◽  
pp. 484.e1-484.e8 ◽  
Author(s):  
Young Ho Shin ◽  
Jun O Yoon ◽  
You Keun Kim ◽  
Jae Kwang Kim
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Psychological Status ◽  
Tunnel Syndrome

scholarly journals Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients

2019 ◽  
Vol 109 (4) ◽  
pp. 343-350
Author(s):  
J. Multanen ◽  
J. Ylinen ◽  
T. Karjalainen ◽  
H. Kautiainen ◽  
J. P. Repo ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Severity Scale ◽  
Floor Effect ◽  
Symptom Severity Scale ◽  
Boston Carpal Tunnel Questionnaire ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire

Background and Aims: The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties. Materials and Methods: We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test–retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects. Results: The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach’s alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test–retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants. Conclusion: Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.

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