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No Predictive Value For Electrodiagnostics After Carpal Tunnel Surgery
A DGReview of :"Clinical outcome and predictive value of electrodiagnostics in endoscopic carpal tunnel surgery"
Neurosurgical Review
08/09/2002
By Anne MacLennan
Electrophysiological monitoring of postoperative nerve conduction is not a useful predictor of the clinical course of individuals with carpal tunnel syndrome, suggests a study in Germany.
Drs T. Vogt and J. Scholz from University Hospital Mainz, Mainz, wanted to determine both clinical outcome and electrophysiological recovery of the median nerve after endoscopic transection of the transverse carpal ligament (TCL) in these patients.
All 43 patients in the prospective study had clinically and electrophysiologically confirmed carpal tunnel syndrome. In total, 50 hands were affected.
The evaluation process included a questionnaire on symptoms, physical examination, grip force measurements and electrophysiological testing before surgery and then again at weeks four and 20 after surgery.
As compared with pre-surgery baseline rates, postoperative rates of permanent paraesthesia, pain, the presence of Tinel's sign and thenar atrophy had all decreased significantly. Furthermore, almost all of the patients (94 percent) had no residual disturbances and were satisfied with the results.
In 4.5 percent of the group, the treatment had to be changed to an open release when complications were observed.
However, although nerve conduction studies (NCS) showed significant improvement, many were still abnormal after four months.
Since failure of improvement could not be predicted on the basis of the electrophysiological data, monitoring of postoperative nerve conduction is not very sensitive in characterising the individual clinical course, suggest the authors.
All of the study patients spent 3.3 days in hospital. However, their time of return to work differed by type of employment.
The self-employed returned to work in 4.3 days; those working as employees returned in 19 days.
Neurosurg Rev (2002) 25: 218-221.
"Clinical outcome and predictive value of electrodiagnostics in endoscopic carpal tunnel surgery"
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