Predictors of Future Contralateral Carpal Tunnel Release at the Time of Unilateral Surgery

Prognostic indicators of postoperative objective improvement in carpal tunnel syndrome: A retrospective study

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy affecting the upper limb, with surgical intervention as the primary treatment. This study aims to identify predictive factors influencing postoperative motor and sensory recovery following carpal tunnel release (CTR).

METHODS

A retrospective analysis was conducted on 95 patients (117 hands), with objective outcomes measured by tip pinch strength and two-point discrimination (2PD) six months postoperatively. Motor recovery was defined as the recovery rate of tip pinch strength ≥ 1.2, while sensory recovery was defined as 2PD < 6 mm. Predictive factors such as age, gender, body mass index, comorbidities, and preoperative physical strength were analyzed using univariate and multivariate logistic regression.

RESULTS

Our study showed that younger patients (<73 years) and those patients with better preoperative sensory function had better significant postoperative sensory recovery (age: OR 5.5p = 0.003, 2PD: OR 3.3p = 0.042). Preoperative pinch strength was a significant predictor of motor recovery, while the presence of diabetes mellitus was associated with poorer sensory recovery. Although subjective measures such as the Quick DASH and visual analog scale improved postoperatively, they did not correlate with objective motor and sensory recovery.

CONCLUSIONS

These findings suggested the importance of preoperative differences in pinch strength, sensory function and age in predicting postoperative prognosis in patients with CTS. Understanding these prognostic factors may help clinicians to provide patients with different measures of subjective improvement and to manage their expectations.

Predicting Contralateral Surgery for Trapeziometacarpal Arthrosis Within 5 Years

PURPOSE

Symptomatic trapeziometacarpal (TMC) joint arthritis is a common cause of hand pain. It is unknown how many patients ultimately elect to have bilateral surgery for TMC arthritis. In this study, we assessed the frequency and predictive factors for contralateral TMC surgery in patients who underwent prior TMC surgery.

METHODS

We identified 712 patients who underwent primary surgery for TMC arthritis with a follow-up period of 5 years. We collected demographic, surgical, and follow-up data. Prediction models for contralateral surgery using a training and testing data set were created with multivariable logistic regression and random forest classifier algorithms.

RESULTS

At the time of initial surgery, 230 patients had bilateral thumb pain (32%), but only 153 patients ultimately had an operation for TMC arthritis on the contralateral side within 5 years (21% of 712 total patients and 67% of 230 patients with bilateral pain). Common predictive factors between both models for contralateral surgery were younger age (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.93-0.98), bilateral thumb pain (OR = 3.76; 95% CI, 2.52-5.65), and anxiety disorders (OR = 1.84; 95% CI, 1.11-3.03).

CONCLUSIONS

In our study, we found that the rate of contralateral surgery was 21% in patients who underwent prior TMC surgery. Predictive factors for future contralateral surgery included younger age, bilateral thumb pain, and anxiety disorder at the time of initial surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Factors affecting contralateral wrist surgery after one carpal tunnel release in bilateral carpal tunnel syndrome

Carpal tunnel syndrome (CTS) can be bilateral, with varying incidence. Carpal tunnel release (CTR) in one wrist may relieve the symptoms of the contralateral wrist, avoiding the need for second surgery; conversely, the symptoms may persist or worsen, requiring contralateral surgery in some cases. The present study investigated whether surgical treatment was finally required for the non-operated CTS wrist, and in what cases non-operative treatment was possible. We compared baseline characteristics, risk factors and electrodiagnostic data between CTS patients who underwent only unilateral CTR and those who subsequently underwent bilateral surgery at various time intervals. This single-center retrospective study included 188 patients with bilateral CTS managed between 2010 and 2020; 137 patients (group 1, 73%) underwent only unilateral CTR, and 51 (group 2, 27%) subsequently underwent contralateral CTR. In group 1, contralateral CTS symptoms were assessed in 4 categories and compared to the presenting symptoms in the index wrist. There were no significant differences in age, gender, preoperative symptom duration, body status, addictive behavior, electrodiagnostic study or comorbidities, other than a higher rate of dialysis in group 2. The contralateral wrist showed partial or complete symptom relief in 57% of patients undergoing unilateral CTR. High BMI and history of diabetes were risk factors for persistent severe CTS or subsequent contralateral CTR.