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Carpal Tunnel Syndrome and the Unmeasured Strength
J. Christopher Gayton, MD1; Mark Miller, PHD1; Mark E. Baratz, MD2; Bradley A. Palmer, MD1
1Allegheny General Hospital, Pittsburgh, PA; 2Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction: Pinch and grip strength are commonly used measures of hand strength in evaluating the success of carpal tunnel release. These measures do not correlate well with activities of daily living. For example, many patients have difficulties with activities requiring both gripping strength and twisting strength, such as opening jars, opening doors, and turning keys. Our objective was to evaluate twisting strength in patients undergoing carpal tunnel release and compare this to standard pinch and grip testing.

Materials and Methods: 39 patients (27 females and 12 males) with carpal tunnel syndrome were prospectively enrolled prior to limited open carpal tunnel release by a single hand surgeon. Patients were evaluated pre-operatively and at 3, 6, and 12 months postoperatively for twisting strength. DASH, Visual analog score (VAS), standard pinch and grip testing were also obtained at each visit. Twisting strength was measured by turning a device with disks of 2.5 cm (pinch and twist) and 10 cm (grip and twist) diameter to simulate pinch and grip strength. The disk sizes were selected to simulate opening bottles and jars, respectively. ANOVA and Tukey pairwise comparisons were done for statistical analysis.

Results: Twisting strength with the 10 cm disk (grip and twist) was significantly improved at 12 months follow-up in both males and females 46.3 to 77.8 in lbs (p< 0.001). Twisting strength of the 2.5 cm disk (pinch and twist) improved from 9.1 to 12.3 in lbs (p= 0.024). VAS and DASH were significantly improved from 3.9 to 0.7 (p < 0.001) and 33.6 to 11.7 (p < 0.001) respectively. Standard pinch or grip testing levels remained at preoperative levels at all timepoints.

Conclusions: Twisting strength in both the 2.5 and 10 cm disk was significantly improved at 12 months in both males and females after carpal tunnel release. Historical studies evaluating pinch and grip strength have shown a return to preop levels around 3 months. Our patients demonstrated similar recovery of standard pinch and grip, as well as improved VAS and DASH scores with an improvement in twisting strength at 12 months after carpal tunnel decompression. Patients can be reassured that there should be no loss of grip strength following carpal tunnel release. Patients should also expect an improvement in the ability to open bottles and jars. As pain decreases after carpal tunnel release, patients gain improved ability to perform ADLs requiring twisting strength.

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