Open carpal tunnel release provides long-term symptom relief

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1. In patients who underwent open carpal tunnel release (OCTR), 74% reported complete symptom resolution at 10 year follow-up.

2. At 10 year follow-up, 88% of patients were completely satisfied or very satisfied with the surgery. 

Study Rundown:  Strong functional, symptom, and satisfaction scores at 10 year follow-up demonstrate both the efficacy and durability of the open carpal tunnel release (OCTR) procedure.  Only 12% of patients reported the classic carpal tunnel symptom of nocturnal pain.  The high patient response rate of 72%(113/157) and the use of a validated questionnaire are marked strengths of this study.  It is however limited by a lack of preoperative symptom and dysfunction scores, prohibiting analyses to quantify improvement.  The study also lacks a control group.  Despite its limitations, this study serves to reinforce the excellent long-term outcomes of open carpal tunnel release.

Click to read the study in The Journal of Bone and Joint Surgery

Click to read an accompanying editorial in Journal

Relevant Reading: Carpal Tunnel Syndrome

In-Depth [retrospective Cohort Study]:  The report included 113 patients who underwent open carpal tunnel release (OCTR) from 1996 to 2000 at a single institution by a single surgeon.  Patients were identified by ICD-9 billing codes and CPT procedural codes and were excluded if they underwent an additional procedure on the index hand or upper extremity, had an endoscopic carpal tunnel release (ECTR), refused participation, or were deceased.  If a patient underwent bilateral OCTR, only the first procedure was included.  Patient symptoms and function were evaluated by the Levine-Katz carpal tunnel instrument which employs a 5 point ordinal response scale (1 point = no pain, symptoms, or limitations. 5 points = severe pain, symptoms, limitations).  A score of greater than 2 was considered a poor symptom or function score.  Two additional questions were included to evaluate symptom resolution after one year and patient perception of the effect of surgery on their carpal tunnel symptoms.  The average time to follow-up was 13 years and the mean age at the time of surgery was 52 years ± 14.  The mean Levine-Katz symptom score was 1.3 ± 0.5, the mean function score was 1.6 ± 0.8. Of those reporting both pain and function scores, 42%(46/113) reported 1 for both indicating no symptoms or functional impairment.  By 1 year, 72% of patients reported complete symptom resolution and at 10 years, that increased to 74%.  The classic carpal tunnel symptom of nocturnal pain was reported by only 12% of patients.

By Chaz Carrier and Allen Ho

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