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Outcomes after carpal tunnel release in breast cancer patients: a case-control study
Isaac Mordukhovich, BA, Christina Dami Lee, DO MS, Mazen Al-Malak, MD, Ying Ku, DO, Jacob Lammers, DO, Bahar Bassiri Gharb, MD, PhD; Antonio Rampazzo, MD, PhD
Cleveland Clinic, Cleveland, OH
Purpose: Peripheral neuropathies have been reported as consequences for locoregional and systemic breast cancer therapies. Carpal tunnel syndrome (CTS) is among the neuropathies identified, but there exists a paucity of research evaluating the management of CTS in this patient population and the effectiveness of carpal tunnel release (CTR) for symptomatic relief.
Methods: A retrospective case-control chart review study was performed in the Cleveland Clinic's Electronic Medical Record. Study inclusion criteria: female patients over 18 years old with histories of CTS and CTR. The case group required prior treatment of breast cancer not arising from metastasis. Chi-square, Welch's, and Fisher's tests were performed with appropriate corrections. Summary statistics are reported as mean ± standard deviation.
Findings: Ninety-eight patients were included in the case (BRCA) group with 200 control patients. Despite efforts to match patients, BRCA patients were older than controls (63.1±11.9 vs. 51.1±12.8 years, p<0.01). The control group was more likely to have chronic kidney disease than the BRCA group (p<0.01), although other CTS-predisposing comorbidities had equal occurrences between groups. BRCA subjects were treated for ductal or lobular carcinomas at stage 1 (78.9%), stage 2 (18.3%), or stage 3 (2.8%) with breast-conserving surgery (67.0%), simple mastectomy (21.6%), modified radical mastectomy (7.2%), or other, non-radical mastectomy (4.1%). Adjunctive treatments included axillary surgery (38.8%), radiation (17.3%), chemotherapy (31.6%), SERM (57.1%), and immunotherapy (6.1%).
Upon CTS diagnosis, the BRCA group was treated with conservative measures for shorter durations (p<0.01) than the control group (
Figure 1). The BRCA group was also less likely to be treated with orthosis or steroid injections (p<0.05) without any difference in subjective improvement (p=0.725). Following CTR, both groups' DASH improvements were clinically significant (?DASH
BRCA=40.01±19.29, ?DASH
control=24.14±23.98). The BRCA group's relative DASH (p=0.034), BCTQ-F (p<0.01), and BCTQ-S (p<0.01) reductions following CTR were greater than those of the control group (
Figure 2).
Conclusion: Breast cancer patients had greater reductions in CTS severity following CTR and similar responses to conservative therapy compared to other patients despite abbreviated conservative treatment durations. The observed accelerated transition from conservative to surgical treatment of CTS in patients following breast cancer is therefore effective and medically justified.
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