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Carpal tunnel release surgery ineffective in 38% of wrists in elderly.

TUCSON, ARIZ. -- Elderly patients can benefit from open carpal tunnel release surgery, but a larger than expected number experience persistent disability after surgery, a new study revealed.

Although the incidence of carpal tunnel syndrome increases with age, the results of open carpal tunnel release surgery have been primarily reported in relatively young, more active patients.

But a recent study suggested improvement in symptoms and function is negatively correlated with increasing age (J. Bone Joint Surg. Br. 2002;84:688-91).

The current study involved 100 consecutive patients, aged 75 years or older, and showed that 38% of wrists had continued disability 2 years after surgery.

"It's not that the results are bad; it's just that in younger people the results are better--in the 98% range--and we tend to extrapolate that to other populations," Dr. Peter Murray said at the annual meeting of the American Association for Hand Surgery.

Factors such as wrist degenerative arthritis, diabetic peripheral neuropathy, and cognitive dysfunction may have played a role in patients' perceived level of postoperative disability.

The findings do not change the indications for surgery in the elderly but suggest careful preoperative evaluation of other causes of hand and wrist disability in these patients, said Dr. Murray of the department of orthopedic surgery, Mayo Clinic, Jacksonville, Fla.

"We also recommend a very frank preoperative discussion with patients and family regarding the potential for limited improvement following open carpal tunnel release surgery," he said.

Dr. Murray and colleagues reported data from 69 patients and 81 open carpal tunnel release surgeries performed at the Mayo Clinic by one of two hand surgeons using identical techniques. The remaining 31 patients were either deceased or unable to participate. Average patient age at surgery was 79 years (range 75-89), 55% were women, and 12% (8 of 69) had diabetes mellitus.

Patient outcomes were assessed with the Mayo wrist and disabilities of the arm, shoulder, hand (DASH) scoring systems. The average follow-up was 24 months (range 8-60 months).

Preoperative nerve studies showed an average distal medial latency of 6.9 milliseconds, and 16 patients had no nerve conduction response. Five patients had no improvement post surgery. Of the 28 who returned for a physical exam, 17 (61%) had abnormal median nerve sensory testing. Based on fair or poor Mayo/DASH scores, the authors considered 22% of patients (15 of 69) and 38% of wrists (31 of 81) to have continued disability post surgery.
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Title Annotation:Rheumatology
Author:Wendling, Patrice
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Apr 15, 2006
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