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Do Pre-operative Nerve Studies Predict Time to Resolution of Symptoms After Carpal Tunnel Release?
John Fowler, MD1; Maria Munsch, BS2; William Hagberg, MD2; Joseph E. Imbriglia, MD2
1University of Pittsburgh, Pittsburgh, PA; 2Hand and UpperEx Center, Wexford, PA

Background: Electrodiagnostic studies (nerve conduction studies and electromyography) are commonly ordered prior to carpal tunnel release to confirm the diagnosis and more importantly, to document the severity of the disease process. Patients with mild to moderate carpal tunnel syndrome are counseled that we expect their night symptoms will go away the night of surgery and that their day time symptoms may take somewhat longer. Patients with severe carpal tunnel syndrome, based on nerve studies, are often told that their relief of symptoms will be unpredictable. The purpose of this study is to determine if electrodiagnostic studies predict time to resolution of symptoms.
Methods: After IRB approval, all patients undergoing CTR were prospectively enrolled in this study. Pre-operative 2-point discrimination, presence of symptoms that awaken the patient at night, and presence of daytime numbness were documented. The preoperative electrodiagnostic studies were reviewed and classified as mild, moderate, or severe. Patients underwent open carpal tunnel release and then were contacted by phone within 48 hours. Patients were asked if the nighttime symptoms and daytime symptoms had resolved.
Results: 100 patients were prospectively enrolled. Mild pre-operative studies accounted for 45 patients, moderate 20 patients, and severe 35 patients. Nighttime symptoms resolved within 48 hours in 63/65 (97%) of patients with mild and moderate CTS, compared to 27/35 (77%) of patients with severe CTS, p = 0.01. Daytime symptoms resolved within 48 hours in 51/65 (78%) of patients with mild and moderate CTS, compared to 6/35 (17%) of patients with severe CTS, p = 0.001.
Conclusion: Patient with mild to moderate CTS, based on preoperative electrodiagnostic studies, should expect nighttime symptoms to resolve within 48 hours. Daytime symptoms resolve quickly in the majority of patients with mild to moderate CTS. The majority of patients with severe CTS also experience relief of nighttime symptoms, but daytime numbness does resolve quickly.


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