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American Association for Hand Surgery

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Electrodiagnostic Testing and Carpal Tunnel Release Outcomes in Patients with Severe Carpal Tunnel Syndrome: A Prospective Analysis
Christopher J. Lama, MS1, Vinay Rao, MD1, Ellis M. Berns, BS1, Christopher J. Got, MD2, Manuel F. DaSilva, MD3, Julia A. Katarincic, MD4, Edward Akelman, MD5 and Arnold-Peter C Weiss, MD6, (1)Brown University, Providence, RI, (2)Dept of Orthopedics, Brown University, Providence, RI, (3)Orthopaedic Surgery, The Warren Alpert Medical School at Brown University/Rhode Island Hospital, Providence, RI, (4)Department of Orthopaedic Surgery, Brown University, Providence, RI, (5)Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, (6)Alpert Medical School of Brown University, Providence, RI

Introduction
The utility of electrodiagnostic (EDX) testing in the management of carpal tunnel syndrome (CTS) has been widely debated. Some proponents have argued that EDX are valuable in patients with CTS as a method to predict clinical improvement following carpal tunnel release (CTR). For patients already presenting with severe CTS, the role of pre-operative EDX in predicting clinical sensory and motor recovery has yet to be established.

Materials & Methods
We prospectively evaluated 27 consecutive patients with 28 hands who presented with severe CTS and underwent open CTR. Severe CTS was defined as constant fingertip numbness (CN) and/or thenar atrophy (TA). All patients received pre-operative EDX testing in the form of sensory and motor nerve conduction latency measurements. Clinical improvement was determined by improvement in CN by Semmes-Weinstein (SW) monofilament testing, improvement in motor function by changes in thenar muscle thickness and pinch strength, and overall functional improvement by changes in the qDASH symptom severity scale and the qDASH tingling scale. Patients were followed for a minimum of 3-months post-operatively and up to 1-year. Simple linear regression with Pearson correlations were performed to assess for any significant relationship with pre-operative EDX findings and post-operative improvements following CTR.

Results
Overall, there was an improvement in SW tests, thenar muscle atrophy, grip strength and qDASH scores in all patients following CTR. For patients with CN, there was a statistically significant moderate positive correlation found between severity of pre-operative EDX and percent improvement in SW testing after open CTR at 3-months (R = 0.53, P < 0.05). However, patients with CN did not exhibit a correlation between clinical improvement of numbness and severity of pre-operative EDX when evaluating improvement in qDASH tingling scores after open CTR at 3-months (R = -0.24, P > 0.05). For patients with thenar atrophy, there was no correlation found between pre-operative EDX and changes in thenar muscle thickness (R = -0.02, P > 0.05), or changes in pinch strength (R = -0.43, P > 0.05). Additionally, pre-operative EDX did not correlate with improvement in qDASH scores (R = 0.19 , P > 0.05).

Conclusions
In our prospective cohort study, patients presenting with severe CTS exhibited some degree of improvement in CN and TA following CTR. In patients with severe CTS, pre-operative EDX tests do no correlate with sensory or motor clinical improvement after CTR. Providers should interpret pre-operative EDX findings of patients with severe CTS with caution.


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