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Long-term outcome after carpal tunnel release and identification of prognostic factors

  • Original Article - Peripheral Nerves
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The effectiveness of the surgical treatment of carpal tunnel syndrome (CTS) is well known on short term. However, limited data is available about long-term outcome after carpal tunnel release (CTR). The aims of this study were to explore the long-term outcome after CTR and to identify prognostic factors for long-term outcome.

Methods

Patients with clinically defined CTS underwent CTR and completed the Boston Carpal Tunnel Questionnaire at baseline (T0), at about 8 months (T1), and after a median follow-up of 9 years (T2), as well as a 6-point scale for perceived improvement (at T1 and T2). Potentially prognostic factors were identified by logistic regression analysis and correlation.

Results

At long-term follow-up, 87 patients (40.3%) completed the questionnaires. Mean score on Symptom Severity Scale (2.87 to 1.54; p < 0.001) and Functional Status Scale (2.14 to 1.51; p < 0.001) improved at 8 months and did not change significantly after 8 months. A favorable outcome was reported in 81.6%. A good treatment outcome after 8 months and to a lesser extent a lower FSS score at T0 were associated with a better long-term outcome.

Conclusions

CTR is a robust treatment for CTS and its effect persists after a period of 9 years. The most important factor associated with long-term outcome is treatment outcome after about 8 months and to a lesser extent functional complaints preoperatively. Outcome is independent of patient characteristics, electrodiagnostic test results, or findings at the initial neurological examination.

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Acknowledgments

The authors would like to thank all the participants who participated in this study.

Funding

This research received no funding.

Author information

Authors and Affiliations

  1. Department of Neurology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, The Netherlands

    Floriaan G. C. M. De Kleermaeker, Jan Meulstee & Wim I. M. Verhagen

  2. Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands

    Ronald H. M. A. Bartels

Authors
  1. Floriaan G. C. M. De Kleermaeker
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  2. Jan Meulstee
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  3. Ronald H. M. A. Bartels
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  4. Wim I. M. Verhagen
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Corresponding author

Correspondence to Floriaan G. C. M. De Kleermaeker.

Ethics declarations

Ethics approval

Permission from the local Medical Ethics Committee (Arnhem Nijmegen) was obtained. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Comments

This is a well designed prospective study that looks at the outcome of patients undergoing open Carpal Tunnel Release surgery at both intermediate (8 months) and long (9 years) term postoperative time points. The results are in line with other retrospective, prospective, and the few randomized clinical trial studies that have been done. However there are few studies that have looked at the results at such long term postoperative time points and correlated outcome, both intermediate and long term, with both preoperative baseline clinical features, as assessed by standardized and validated questionnaires, and diagnostic test results (using both electrodiagnostic and ultrasound modalities). This study confirms that patients can continue to improve over many years and that such improvement is maintained in the majority of patients. It is not surprising that the few patients with very severe disease did not have a high success rate. It is also reassuring that only a few patients underwent a re-operation. This study has limitations which are well described in the discussion. Overall, it makes an important contribution to the literature confirming the long term benefits of Carpal Tunnel Release Surgery.

Michel Kliot

CA, USA

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De Kleermaeker, F.G.C.M., Meulstee, J., Bartels, R.H.M.A. et al. Long-term outcome after carpal tunnel release and identification of prognostic factors. Acta Neurochir 161, 663–671 (2019). https://doi.org/10.1007/s00701-019-03839-y

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  • DOI: https://doi.org/10.1007/s00701-019-03839-y

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