Differences in the Postoperative Outcomes According to the Primary Treatment Options Chosen by Patients With Carpal Tunnel Syndrome: Conservative Versus Operative Treatment

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Abstract

Purpose

We prospectively analyzed the differences in the preoperative status and final outcomes between patients with or without the motivation for prompt surgery after a recent diagnosis of carpal tunnel syndrome (CTS).

Methods

One hundred fifty-six patients were enrolled and followed up from a cohort of 220 patients who were diagnosed with CTS between 2011 and 2013. Basic demographic factors, including the occupational features, were investigated in group 1 (n = 52, conservative treatment followed by surgery) and group 2 (n = 100, surgery immediately after diagnosis). The preoperative electrodiagnosis, clinical items by Graham, Disabilities of the Arm, Shoulder, and Hand (DASH) outcomes questionnaire, Boston Carpal Tunnel Questionnaire scores, and grip/pinch strengths were evaluated, and the degree of improvements was compared.

Results

The onset period of the symptoms or signs, as well as the time from the diagnosis to surgery, was significantly longer in group 1 than in group 2. In group 1, nonprofessional, simple, and repetitive jobs were more prevalent; however, the professional category was more common in group 2. The preoperative distributions among the electrodiagnostic grades were not different in both groups. Most of the clinical items by Graham were more definitively improved in group 2. DASH improvement at the final follow-up was meaningfully more in group 2 (34 ± 5.3) than in group 1 (29 ± 6.5). Boston Carpal Tunnel Questionnaire showed a similar trend regarding the DASH score (preoperative, improvement at the final follow-up) with statistical significance. The increase in grip/pinch strength was also greater in group 2.

Conclusions

Most patients, who refused/delayed surgery as the initial treatment for CTS, were not improved by conservative options. Eventually, carpal tunnel release was performed; however, the overall outcomes were inferior compared with those of the groups who agreed to operative treatment as the initial option.

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