Preoperative Axonal Loss on Electrodiagnostics as a Prognostic Factor for Favorable Patient-Reported Improvement Following Carpal Tunnel Release
Nicholas Livingston, BA1, Eric X Jiang, MD2, Alisha Williams, BS1, Logan Hansen, MD3, 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
Purpose: Carpal tunnel syndrome (CTS) impacts the functionality of the wrist and hand, potentially leading to denervation of thenar muscles and axonal loss (AL). While carpal tunnel release (CTR) is an effective treatment for CTS, it is unknown whether AL impedes CTR outcomes. This study aims to investigate the impact of AL on the outcomes of CTR.
Methods: A cohort of patients who underwent open and endoscopic CTR by 4 hand fellowship trained orthopedic hand surgeons, following preoperative electromyography and nerve conduction studies, were retrospectively identified. Demographic information, preoperative, and 3-month postoperative patient reported outcome (PRO) questionnaires including QuickDASH, PROMIS Pain Interference (PI), and PROMIS Upper Extremity (UE) were obtained via chart review. The differences between pre and post-operative PROs were calculated for patients with and without AL, and rates of minimal clinically important difference (MCID) achievement were determined. Statistical analysis included paired t-tests for pre and post-operative PRO differences, demographics with chi-squared tests, and MCID achievement rates with Fisherâ€™s exact test.
Results: 23 out of 165 patients had evidence of axonal loss. There were no significant differences in mean follow-up or demographic data between the groups (with and without AL). Additionally, there were no differences in preoperative QuickDASH (p=0.18), PI (p=0.93), or UE (p=0.52) scores. Patients with axonal loss demonstrated significantly greater improvement in QuickDASH scores compared to those without (p=0.02, Figure 1), and achieved QuickDASH MCID at higher rates (p=0.01, Figure 2). Although not statistically significant, the trend of greater improvement and higher MCID achievement was also demonstrated on the PROMIS UE responses (UE score change: p=0.06, Figure 1; UE MCID achievement rate: p=0.08, Figure 2). There was no significant difference in PI score change (p=0.34) or rate of achieving PI MCID (p=0.31).
Conclusion: Patients with severe CTS and evidence of axonal loss experience greater subjective improvement following CTR as measured by QuickDASH and achieve MCID at higher rates than those with milder disease states. These findings suggest that CTR should be recommended for patients with axonal loss, and better informs physicians as they discuss expectations of the results of CTR with patients. Future studies are needed to confirm these results and determine the long-term outcomes of CTR for patients with severe CTS.
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