Long-Term Outcome of Electrodiagnostic Values and Symptom Improvement After Carpal Tunnel Release: A Retrospective Cohort Study

Sex Is a Better Predictor Than Preoperative Electrodiagnostic Findings for Outcomes After Common Peroneal Nerve Decompression for Compressive Neuropathy: A Retrospective Review

Background

There is increasing interest in the evaluation and management of compressive neuropathy of the common peroneal nerve (CPN).

Purpose

We sought to determine demographic and electrodiagnostic predictors for resolution of symptoms after CPN decompression for compressive neuropathy. We hypothesized that severity of neuropathy (as measured by compound motor amplitudes and active or chronic denervation on electromyography) would be associated with symptom resolution after CPN decompression.

Methods

We performed a retrospective review of patients who underwent CPN decompression and had preoperative electrodiagnostic (EDX) studies at a single institution from January 1, 2015, to April 30, 2023. We performed independent samples t-test and logistic regression to evaluate demographic and EDX study factors associated with symptom resolution.

Results

Of the 44 patients identified, 33 reported resolution of preoperative symptoms, with no differences based on EDX findings. The likelihood of symptom resolution was significantly higher in men than women (OR = 10.62; 95% CI = 1.218, 92.677). Patient demographics were otherwise not predictive of symptom resolution.

Conclusion

Three-quarters of our patients reported symptom resolution after CPN decompression for compressive neuropathy. While EDX studies were not predictive of outcomes, our findings suggest that sex-based factors may be contributing to outcomes. This deserves further investigation, as outcomes after surgery may be driven by preoperative characteristics such as surgeon counseling, patient expectations, or other biologic factors.

Long-term patient-centered outcomes following carpal tunnel release surgery: a 10-year follow-up

INTRODUCTION

Carpal Tunnel Syndrome (CTS) is a painful orthopedic hand condition caused by compression of the median nerve at the wrist. Diagnosis is typically clinical, relying on patient's symptoms and physical examination findings, but confirmation often requires electrodiagnostic studies. Previous research on CTS has explored the relationship between median nerve compression severity and various outcomes. However, these studies have been limited by short follow-up durations, small to modest patient cohorts, and a narrow focus on patient-reported outcomes. The objective of this study was to provide a long-term, 10-year follow-up with a relatively large patient cohort, focusing on new patient-reported outcomes and their association with the severity of nerve compression.

METHODS

A retrospective cohort study was conducted on a total of 581 patients who underwent open carpal tunnel release surgery between 2013 and 2023 at a major teaching hospital in Jordan. Severity was categorized based on nerve conduction study results into three groups: mild, moderate, and severe and Six distinct outcomes of interest were examined.

RESULTS

No significant differences in age, health profiles, comorbidities, or disease presentation were observed among the severity groups. However, significant variations were found across the six outcomes. Patients with severe disease had longer recovery times (p < 0.01), less pain relief (p = 0.03), reduced satisfaction (p = 0.04), diminished functional improvement (p < 0.01), lower ADL improvement (p < 0.01), yet experienced better sleep quality improvement (p < 0.01).

CONCLUSION

Long-term follow-up post-open carpal tunnel release surgery revealed that severe cases experienced longer recovery times, less pain relief, reduced satisfaction, diminished functionality improvement, and lower ADL improvement, but better sleep quality.

LEVEL OF EVIDENCE

Level III, Retrospective cohort study.

Self-Reported Improvement After Carpal Tunnel Release in Patients With Motor Axonal Loss

PURPOSE

Electrodiagnostic studies can identify evidence of sensory and motor axonal loss (AL) in carpal tunnel syndrome (CTS) patients. However, the impact of sensory and motor AL on outcomes following carpal tunnel release (CTR) remains unclear. We hypothesize that patients with no evidence of sensory and motor AL will experience greater improvement following CTR compared to those with evidence of AL.

METHODS

Patients undergoing open and endoscopic CTR by four fellowship-trained orthopedic hand surgeons were identified. Sensory and motor AL were identified using preoperative electromyography and nerve conduction studies. Patients completed the following before surgery and 3-month postoperative patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) and Pain Interference (PI) as well as Disabilities of the Arm, Shoulder, and Hand (QuickDASH [QD]). Preoperative and postoperative scores, changes in scores, and rates of achieving the minimally clinically important difference (MCID) were compared between patients with and without sensory and motor AL.

RESULTS

One hundred and seventy-five patients were included. Of these, 91 exhibited sensory AL and 98 exhibited motor AL. Demographic matched analysis of patients with and without sensory AL showed no differences in before surgery, after surgery, difference, or proportion meeting MCID for UE, PI, or QD. Matched analysis revealed no difference in preoperative PROMs between patients with and without motor AL. Patients with motor AL had increased postoperative UE (better function), decreased postoperative PI (less PI) and QD (less disability), increased changes in PI and QD, as well as a greater proportion meeting MCID for QD compared to those without motor AL.

CONCLUSIONS

There was no difference in post-CTR improvement between patients with and without sensory AL. However, contrary to our hypothesis, motor AL patients experienced greater postoperative improvement according to QD. These findings suggest surgery should be recommended for severe CTS patients with evidence of AL. These results can better inform physicians and patients as they discuss expectations of CTR outcomes.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognosis II.

The Role of Confirmatory Testing in Carpal Tunnel Syndrome: Electrodiagnostic Study, Ultrasound and CTS-6

Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy. The reference standard for the diagnosis of CTS remains an area of controversy. The diagnosis can be established clinically, but options for confirmatory testing include electrodiagnostic studies, ultrasound and diagnostic aids such as the CTS-6 score. This review article summarises the current evidence for each confirmatory testing modality, contrasts their advantages and disadvantages and discusses future directions for investigation. Level of Evidence: Level V (Diagnostic).

Point of care ultrasound combined with CTS-6 to diagnose idiopathic carpal tunnel syndrome

BACKGROUND

This study aimed to demonstrate the effectiveness of our new diagnostic chart using point of care ultrasound combined with CTS-6 for diagnosing idiopathic carpal tunnel syndrome.

METHODS

We conducted a retrospective analysis of the data of patients who visited our department and received point of care ultrasound combined with CTS-6 from 2020 to 2023. Data regarding age, sex, initial and final diagnosis, cross-sectional area of the median nerve, CTS-6 score, and electrodiagnostic severity were obtained and statistically analyzed.

RESULTS

Of the 177 wrists included in our study, 138 (78 %) were diagnosed with carpal tunnel syndrome, while 39 (22 %) were not (non-carpal tunnel syndrome). With our diagnostic method, 127 wrists (72 %) were diagnosed initially with carpal tunnel syndrome, 23 wrists (13 %) with non-carpal tunnel syndrome, and the rest 27 wrists (15 %) as borderline. Our initial diagnoses of carpal tunnel syndrome and non-carpal tunnel syndrome were maintained in all cases except for two. Cross-sectional area, CTS-6 score, and electrodiagnostic severity showed a positive correlation. A post hoc analysis showed that the new scoring system (CTS-6 score + 2 × cross-sectional area) with a cutoff value of 31.25 points showed a sensitivity as high as 95 % and a specificity of 100 %.

CONCLUSIONS

Our findings suggest that most suspected idiopathic carpal tunnel syndrome cases can be diagnosed correctly using the diagnostic chart. Although additional tools, including electrodiagnostic studies, may be needed for borderline cases, the use of point of care ultrasound combined with CTS-6 may be a recommendable first-line confirmatory test because point of care ultrasound and CTS-6 could be complementary tools, and this chart may be especially beneficial for atypical or outlier cases.

LEVEL OF EVIDENCE

Diagnostic III.

Carpal Tunnel Syndrome Electrodiagnostic Severity is Not Associated with PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity

Background: The primary objective of this study was to determine the association between preoperative electrodiagnostic study (EDS) parameters and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments in patients with EDS-confirmed carpal tunnel syndrome (CTS). Methods: A retrospective study of 45 patients with EDS-confirmed CTS was conducted. Patients completed the PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity. Explanatory variables included EDS disease severity (mild, moderate and severe), sensory peak latency, sensory amplitude, motor latency, motor amplitude, the presence of nonrecordable sensory latency and the presence of nonrecordable sensory amplitude. Explanatory variables also included patient-related factors, such as age, sex and diabetes mellitus. Associations between variables were assessed using simple linear regression, analysis of variance (ANOVA) and Student's t-test. Results: In our cohort, the EDS severity was mild in 38%, moderate in 42% and severe in 20% of patients. The mean PROMIS Upper Extremity score was 44.4, the mean PROMIS Pain Interference score was 53.5 and the mean PROMIS Pain Intensity score was 49.9. Bivariate analysis demonstrated no association between EDS severity overall or any EDS parameter individually and PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity. Diabetes mellitus was associated with poorer PROMIS Upper Extremity scores. Conclusions: EDS severity is not associated with PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity. Carpal tunnel release is commonly indicated for pain and dysfunction, but validated measures of pain and dysfunction do not correlate with EDS severity. Level of Evidence: Level III (Diagnostic).