Changes in Cross-sectional Area of the Median Nerve and Boston Carpal Tunnel Questionnaire Scores After Carpal Tunnel Release
Nicholas F Aloi, BS1; John R Fowler, MD2; Haris Rahman, BS1
1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction: We hypothesized that postoperative Boston Carpal Tunnel Questionnaire Scores (BCTQ) and ultrasound (US) measurements of the median nerve cross-sectional area (CSA) at the distal wrist crease are significantly decreased at 2-week, 6-week, and ? 6 months follow up appointments, compared to baseline values.
Methods: This study was a retrospective analysis of patients who presented to a single hand clinic with evidence of carpal tunnel syndrome over a six-year period (2014-2020). Patients received baseline US measurements of the median nerve CSA as well as completion of the BCTQ. Post-operative US measurements and questionnaire scores were obtained at 2 weeks post-op, 6 weeks post-op, and ? 6 months after surgery. BCTQ scores were separated based on Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Statistical analyses included a one-way ANOVA to compare the baseline values to the post-operative values, followed by pairwise comparisons via Tukey HSD post-hoc tests to evaluate differences between the means. Pearson’s Correlations examined the relationships between median nerve CSA and BCTQ scores, at each of the timepoints. Statistical significance was set at p<0.05.
Results: This study included 224 separate wrists. Median nerve CSA measurements were 13.2±4.5 mm2 at baseline, 11.9±3.6 mm2 at 2 weeks post-op, 11.6±4.5 mm2 at 6 weeks post-op, and 11.7±4.4 mm2 at 6 months or more (p=0.002)). Pairwise comparisons indicated significant differences between baseline median nerve CSA and all three post-op timepoints (all p<0.04). BCTQ SSS scores were 3.14±.76 at baseline, 1.76±.63 at 2 weeks, 1.68±.70 at 6 weeks, and 1.41±.64 at 6 months or longer (p<0.001). Pairwise comparisons indicated significant differences between baseline SSS scores and all three post-op timepoints (all p<0.001), and between 2 weeks vs. 6 months or more SSS scores (p=0.002). BCTQ FSS scores were 2.56±.89 at baseline, 2.03±.1.0 at 2 weeks, 1.65±.77 at 6 weeks, and 1.36±.61 at 6 months or longer (p<0.001). Pairwise comparisons indicated significant differences between baseline FSS scores and all three separate post-op timepoints (all p<0.001), and between 2 weeks vs. 6 weeks (p=0.003) and 2 weeks vs. 6 months or more FSS scores (p<0.001). The relationships between median nerve CSA and BCTQ scores are listed in Table 1.
Conclusion: These findings demonstrated a sustained decrease (improvement) in baseline median nerve CSA and patient-reported outcomes following CTR at 2 weeks, 6 weeks, and after 6 months.
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