AGE-RELATED OUTCOME IN CARPAL TUNNEL SURGERY: A PROSPECTIVE STUDY

Abstract

This study was designed to determine the outcome following carpal tunnel decompression in relation to patient age. The outcome measure used was a previously published self-administered validated questionnaire which measured symptom severity and functional status in a prospective study of 91 patients undergoing carpal tunnel release. Diagnosis was made on clinical grounds and pre-operative electrophysiology tests. Patients with inflammatory disease, metabolic disorders, pregnancy and carpal tunnel syndrome secondary to trauma were excluded.

Each patient completed the questionnaire and underwent nerve conduction studies prior to surgery, and both were repeated 6 months after surgery. The change in symptom-severity and functional status scores were calculated. Four patients failed to attend review, leaving 87 patients in the study. There were 50 women and 37 men, with a mean age of 59. 8 years (range 31–91).

Ninety percent of patients improved on symptom score and 82% on function score. There was a negative correlation between symptom improvement and age (p=0. 003), and functional status and age (p=0. 046). The greatest difference in outcome was between those patients over 60 years and those 60 or under (p=0. 001 for symptoms and p=0. 034 for function). Both age groups, however, improved significantly in symptom and function scores following surgery (p< 0. 001 for both groups). There was no age group which did not show a significant improvement in outcome, including the very elderly.

Improvement in nerve conduction tests also declined over 60 years of age (p=0. 027).

However, there was no correlation between pre-operative questionnaire scores and nerve tests.

There was also no correlation between outcome and patient sex or symptom duration.

Ten patients expressed dissatisfaction with surgery (7 over 60 years), and a further 10 patients scored their surgery as neutral (7 over 60). These results show that patients over 60 show lower improvement in symptoms and function following carpal tunnel release than younger patients, and 1:3 fail to express satisfaction with the outcome of surgery.