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Age Matters
Jacqueline Watchmaker, BA1; Greg Watchmaker, MD2
1Medical College of Wisconsin, Mequon, WI; 2Orthopaedic Hospital of Wisconsin, Mequon

Introduction: In addressing potential benefits of undergoing carpal tunnel release (CTR) surgery, several standardized tools have been developed. While valuable to the physician scientist, it may be more difficult for the individual patient to relate to these standarized measurement outcomes when assessing their decision for intervention. The goal of the current prospective study was to provide meaningful information to the physician who is regularly faced with the question, "how much will I get better if I decide to have surgery?".

Materials and Methods: 890 consecutive patients undergoing open CTR by a single surgeon were prospectively enrolled. All patients agreed to participate and 91% of patients completed the study through final follow-up data at 6 months. Pre-operative frequency of daytime numbness, nighttime awakening, and duration of symptoms were recorded as part of the intake assessment tool in addition to height, weight, history of diabetes, history of thyroid disease and electrodiagnostic findings. After undergoing CTR, symptom frequency and severity was recorded at defined intervals including final report of symptoms at 6 months. Univariant and multivariate analysis was then performed.

Results: In patients up to age 50 there was a stable and high percentage of symptoms resolution with 70% of patients describing complete resolution of daytime numbness. At age 50 there was a break in the outcomes curve after which there was a linear .53% per year of age decline in daytime symptom resolution. 89% of patients reported complete resolution of nocturnal awakening at 6 months post-operatively. This also demonstrated a statistically significant linear decline after age 50. The study size and high study completion rate allowed age-stratified and whole-group multivariate analysis of factors including diabetes, thyroid disease, BMI, physical exam findings and duration of symptoms. No factor, besides age, was independently correlated with symptom resolution at 6 months.

Conclusions:

  • Age at time of carpal tunnel surgery is a significant factor in predicting symptom resolution in patients with history, physical exam and electrodiagnostic evidence of carpal tunnel. For each year of age older than 50 at the time of surgery, there was a half percent decrease in resolution of daytime numbness post-operatively.
  • All other factors including symptom duration, diabetes, thyroid disease, BMI, exam findings and EMG severity were non-predictive of symptom resolution.
  • Univariate and multivariate analysis demonstrates that age is related to many of these other factors, however, age alone is the independent variable in predicting successful symptom resolution.
  • Age matters.

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