Robert A Weber1, Malcolm J Rude. 1. Section of Hand Surgery, Division of Plastic Surgery, Scott & White Memorial Hospital, 2401 South 31st Street, Temple, TX 76508, USA.
Abstract
PURPOSE: Some hand surgeons have encountered an attitude among referring physicians as well as patients that carpal tunnel release (CTR) is less effective and more morbid in older patients. The purpose of this study was to determine the efficacy of CTR in patients aged 65 and older. METHODS: Patients 65 years of age or older with carpal tunnel syndrome for whom release was indicated were studied prospectively. All patients had a limited palmar incision CTR and a standardized postoperative rehabilitation protocol. The patients' subjective and objective signs and symptoms were measured before surgery and at 6 months after surgery. Scar tenderness and patient satisfaction also were recorded. The Michigan Hand Outcome Questionnaire was used to determine overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function. RESULTS: Seventy-five patients (105 hands) were enrolled; 6-month follow-up data were available on 92 hands on 66 patients. The mean age was 74 +/- 6 years. By patient report, paresthesias, numbness, day pain, night pain, and nocturnal numbness each decreased significantly from severe or very severe to mild or none. All but 2 of the Tinel's signs and one of the Phalen's signs became negative. The mean 2-point discrimination improved from 6.4 +/- 1.3 mm to 4.9 +/- 1.1 mm. Grip and pinch strength increased by 0.9 +/- 7.4 kgf and 0.6 +/- 2.5 kgf, respectively. The Michigan Hand Outcome Questionnaire confirmed a significant improvement in overall hand function, activities of daily living, pain, and satisfaction with hand function. Overall 83% of patients were either very or completely satisfied with their results. CONCLUSIONS: Patients 65 years of age or older objectively benefit and have improved clinical outcomes after CTR. Age alone should not be a contraindication to CTR.
PURPOSE: Some hand surgeons have encountered an attitude among referring physicians as well as patients that carpal tunnel release (CTR) is less effective and more morbid in older patients. The purpose of this study was to determine the efficacy of CTR in patients aged 65 and older. METHODS:Patients 65 years of age or older with carpal tunnel syndrome for whom release was indicated were studied prospectively. All patients had a limited palmar incision CTR and a standardized postoperative rehabilitation protocol. The patients' subjective and objective signs and symptoms were measured before surgery and at 6 months after surgery. Scar tenderness and patient satisfaction also were recorded. The Michigan Hand Outcome Questionnaire was used to determine overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function. RESULTS: Seventy-five patients (105 hands) were enrolled; 6-month follow-up data were available on 92 hands on 66 patients. The mean age was 74 +/- 6 years. By patient report, paresthesias, numbness, day pain, night pain, and nocturnal numbness each decreased significantly from severe or very severe to mild or none. All but 2 of the Tinel's signs and one of the Phalen's signs became negative. The mean 2-point discrimination improved from 6.4 +/- 1.3 mm to 4.9 +/- 1.1 mm. Grip and pinch strength increased by 0.9 +/- 7.4 kgf and 0.6 +/- 2.5 kgf, respectively. The Michigan Hand Outcome Questionnaire confirmed a significant improvement in overall hand function, activities of daily living, pain, and satisfaction with hand function. Overall 83% of patients were either very or completely satisfied with their results. CONCLUSIONS:Patients 65 years of age or older objectively benefit and have improved clinical outcomes after CTR. Age alone should not be a contraindication to CTR.