Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome

This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS) electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up). Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient) to 4 (severe) after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed) and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69 percent). Patient's satisfaction after surgical and non-surgical were respectively, 77.6 percent and 16 percent ("cure"), 13.6 percent and 52 percent (much improved), 5.4 percent and 9.3 percent (little improved), 2.7 percent and 16 percent (unchanged), 0.7 percent and 6.7 percent (worsed). The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value < 0.001) and was not influenced by the CTS electrophysiological severity. There was no relationship between the outcome after surgery and duration of symptomatology, age or CTS severity. Conservative benefice was more prevalent in those with shorter symptomatology and older age; the majority of conservative failure cases had mild initial CTS. We concluded the excellent surgical benefice described by patients and the absence of any predictive factors based on CTS severity, age or duration of symptomatology for outcome

Usefulness of additional nerve conduction techniques in mild carpal tunnel syndrome

This study was done to assess the percentage of abnormality in additional nerve conduction techniques after normal median distal latency (routine) in mild carpal tunnel syndrome (CTS). Bilateral nerve conduction studies were carried out in 116 consecutive symptomatic CTS patients (153 hands). Mild cases were based on normal routine (< 3.7 ms, peak-measured, 14 cm) and at least one technique abnormal of the following: sensory median-radial difference (MR); sensory median-ulnar difference (MU4); mixed palm median-ulnar difference (MUP); median palm latency (PW); and motor median distal latency (MDL). After normal cut-off values for routine, 3.1 to 3.6 ms (< 3.7 ms), we found an abnormal MR, ranging from 86.6 to 93.4 percent, followed by MU4 (40 to 81.7 percent), MUP (20 to 71.2 percent), PW (0 to 41.1 percent), and MDL (0 to 19.6 percent). The most frequent abnormal association were MR plus MU4 in 90.1 percent, followed by MR plus MUP and MU4 plus MUP. The most frequent abnormal additional nerve conduction technique for mild CTS electrodiagnosis was MR, followed by MU4 and MUP. Percentage of MR abnormality was very high regardless of the median routine latency cut-off (< 3.1 to < 3.6 ms)