Does Pre-Operative Electrodiagnostic Testing Predict Time to Resolution of Symptoms After Carpal Tunnel Release
John R. Fowler, MD1; Maria Munsch, BS2; William Hagberg, MD2; Joseph E. Imbriglia, MD2
1Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 2Hand and Upper Ex Center, Wexford, PA
Background: Previous studies have found weak or no correlation between pre-operative electrodiagnostic (EDX) studies and functional and/or subjective outcomes after carpal tunnel release (CTR). However, these studies examined outcomes at 6 months or 1 year, potentially missing early differences in recovery. Our anecdotal experience found that patients with mild carpal tunnel syndrome recovered more quickly than those with severe carpal tunnel syndrome. The purpose of this study is to determine if EDX studies predict time to resolution of symptoms after CTR.
Methods: 61 consecutive patients undergoing open CTR were prospectively enrolled. Preoperative presence of nocturnal symptoms and daytime numbness/tingling were documented. Preoperative EDX studies were reviewed and classified as mild, moderate, or severe. After open CTR, patients were contacted by phone within 48 hours, at 1 week, and then at 2-week intervals for up to 9 months or until both nocturnal and daytime symptoms had resolved. Kaplan-Meir survival curves were constructed and compared using the Wilcoxon and log rank test.
Results: Daytime numbness and tingling in patients with mild carpal tunnel syndrome resolved in a median of 0.4 (95% IQR 0.4-1.4) weeks, moderate carpal tunnel syndrome in a median of 0.4 (95% IQR 0.4-1.4)weeks, and severe in a median of compared to 4.0 (IQR 0.4-24.0) weeks, p = 0.002. Nocturnal symptoms resolved in a median of 0.4 (IQR 0.4-1.4) weeks for patients with mild CTS, median of 0.4 (IQR 0.4-1.4) weeks for patients with moderate CTS, and median of 0.4 (IQR 0.4-0.4) weeks for patients with severe CTS, p=0.3. All symptoms resolved in a median of 0.4 (IQR 0.4-1.4) weeks for patients with mild CTS, 0.4 (IQR 0.4-1.4) weeks in moderate CTS, and 4.0 (IQR 0.4-24.0) weeks in patients with severe CTS, p = 0.04.
Conclusion: Patients with mild or moderate CTS, based on preoperative EDX studies, experience a faster time to resolution of daytime numbness and tingling when compared to patients with severe CTS. Nocturnal symptoms resolved quickly in both groups. The results of this study are in contrast to previous studies that found little to no value of EDX in predicting postoperative functional and subjective outcomes, likely due to the early time points used in the current study. This is not mean to be an indication to obtain EDX, but could be used to counsel patients if obtained for other reasons.
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