Carpal Tunnel Release is Equally Effective in Patients With and Without Double Crush Syndrome
Nicholas Livingston, BA1, Eric X Jiang, MD2, Logan Hansen, MD3, Ani Kazanjian, MD, MPH2, Noah Hodson, MD2, Mitchell Wu, MS1 and Charles S Day, MD, MBA2, (1)Wayne State University School of Medicine, Detroit, MI, (2)Henry Ford Health System, Detroit, MI, (3)Henry Ford Hospital, Detroit, MI
Some individuals with carpal tunnel syndrome (CTS) present with double crush syndrome (DCS), a condition where there is an additional compression or entrapment of the nerve at a proximal site. This study examines the outcomes of carpal tunnel release (CTR) surgery in DCS patients compared to those with CTS alone, assessing changes in postoperative patient-reported outcome measures and the proportion of patients meeting the minimal clinically important difference (MCID) between the two groups.
Chart review identified patients with preoperative nerve conduction studies who underwent CTR at a Midwest, multicenter hospital system. Bilateral CTR, additional procedures, or revision CTR were excluded. Patients completed prospective preoperative and 4-month postoperative PROMIS-Upper Extremity (UE), PROMIS-Pain Interference (PI), and QuickDASH (QD) scores, and responded to the anchor question: "Since your treatment, how would you rate your overall function?". Established MCID values were used to determine the proportion of patients who achieved MCID (Jiang et al.). UE, PI, QD scores were compared using two-tailed t-Tests for normal distributions and the Mann-Whitney U Test for non-normal distributions. MCID proportions and subjective improvement were compared with the Fisher Exact Test. Power analysis determined a minimum sample size of 45 per group was required for significance.
Of 178 total patients, 63 experienced DCS while 115 had CTS alone. There was no significant difference in age or mean follow-up between the groups. At the 4-month follow-up, preoperative, postoperative, and changes in PROMIS-UE, PROMIS-PI, and QuickDASH scores were not statistically different between DCS and CTS patients (Table 1). The proportion of patients achieving MCID for PROMIS-UE, PROMIS-PI, and QuickDASH in the DCS group was 60.0%, 48.4%, and 56.4%, respectively. The proportion of CTS patients achieving MCID for PROMIS-UE, PROMIS-PI, and QuickDASH was 54.0% (p=0.45), 60.5% (p=0.12), 68.8% (p=0.12), respectively (Table 2). No statistical difference was found between the two groups responses to the anchor question (p=0.12).
Patients with DCS are just as likely as those with CTS alone to experience clinically meaningful improvement following carpal tunnel release surgery. Therefore, DCS patients should not be dissuaded from CTR due to concurrent nerve root compression at a proximal site.
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