Patients With Double Crush Syndrome Are As Likely To Improve After Carpal Tunnel Release As Patients With Isolated Carpal Tunnel Syndrome
Michael A Korn, MD1; Eric X Jiang, MD1; Jessi A Fore, BA1; Maxwell T. Yoshida, BS1; Jacob R. Kalkman, B.S.2; Charles S Day, MD, MBA1
1Henry Ford Health System, Detroit, MI; 2Wayne State University School of Medicine, Detroit, MI
Hypothesis: We hypothesized that patients with double crush syndrome (DCS) undergoing carpal tunnel release (CTR) would reach minimal clinically important difference (MCID) at equivalent rates as patients with carpal tunnel syndrome (CTS) alone.
Methods: Retrospective chart review identified patients who underwent unilateral CTR at a Midwest, multi-center hospital system. All patients had a preoperative electromyography study confirming the diagnosis of CTS, and those with concomitant cervical radiculopathy were placed into the DCS group. Patients who underwent bilateral CTR, additional procedures at time of CTR, or revision CTR were excluded from analysis. All patients completed preoperative and three month-postoperative PROMIS-Upper Extremity (UE), PROMIS-Pain Interference (PI), and QuickDASH (QD) surveys, and also answered an anchor question three months after surgery. The percentage of patients who achieved MCID was determined using previously calculated values (Kazmers et al.). Preoperative and postoperative scores were compared using two-tailed T-tests for normal distributions and Mann-Whitney U tests for non-normal distributions. The rates of achieving MCID and the rates of subjective improvement were compared using the Fisher Exact Test.
Results: There were 77 patients included for analysis (55 with CTS alone, 22 with DCS). There was a trend towards younger age in the CTS group compared to the DCS group (55.1 years versus 62.1 years, p=0.06). Males represented 64% of the DCS population, compared to 31% of the CTS group (p=0.01). Preoperative UE, PI, and QD scores were similar between groups. Both groups improved across all domains at three months postoperatively, and there were no observed differences in postoperative scores between the two groups. For the CTS group, the percent of patients achieving MCID for UE, PI, and QD was 74%, 83%, and 84%, respectively, compared to 75%, 71%, and 84% in the DCS group. There was no difference in the rate of achieving MCID between the two groups for UE (p=0.99), PI (p=0.33), or QD (p=0.99). Overall, there was no difference in the percent of patients who rated their function as improved or much improved after surgery (80% of CTS patients, 77% of DCS patients, p=0.78).
Summary: -Patients with DCS experienced significant improvement across all patient reported outcome measures after CTR.
-Patients with DCS had equivalent outcomes as patients with CTS alone, and were equally likely to achieve MCID as patients with isolated CTS.
-While spine pathology may necessitate additional workup and referral, the presence of concomitant cervical radiculopathy should not be a contraindication to CTR.
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