Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release

Sang Jin Cheon; Kyu Pill Moon; Jong Min Lim

doi:10.4055/jkoa.2011.46.6.457

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Cheon, Moon, and Lim: Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(6): 457-463.

Published online: 29 December 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.6.457

Long-Term Changes of the Clinical and Nerve Electrophysiological Findings after Endoscopic Carpal Tunnel Release

Sang Jin Cheon, M.D., Kyu Pill Moon, M.D., Jong Min Lim, M.D.

Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea.

Correspondence to: Jong Min Lim, M.D. Department of Orthopaedic Surgery, Pusan National University School of Medicine, 1-10, Ami-dong, Seo-gu, Busan 602-739, Korea. TEL: +82-51-240-7248, FAX: +82-51-247-8395, deathz75@hanmail.net

Received 21 December 2010 Accepted 28 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to analyze the clinical symptoms and function and the nerve electrophysiological changes between the pre-operative and long-term post-operative states of patients who underwent surgical treatment with endoscopic release of the carpal tunnel for idiopathic carpal tunnel syndrome.

Materials and Methods

This study was performed in 48 patients and 88 wrists with idiopathic carpal tunnel syndrome. All patients were treated with endoscopic carpal tunnel release using a single portal. The preoperative and the 3 years 5 months long-term postoperative clinical symptoms and function were evaluated using the Boston carpal tunnel questionnaire. The nerve electrophysiological status was evaluated using the Bland grade system.

Results

When the preoperative Bland grade was 2, 3, 4, 5, and 6, the range of the change of the symptom severity score was 1.38, 1.68, 2.40, 1.61 and 1.28, respectively, and the range of the change of the functional status score was 0.60, 1.34, 1.58, 0.93 and 0.88, respectively, at the long-term follow-up. The clinical symptoms were signifi cantly improved at the fi nal follow-up when the preoperative Bland grade was 2, 3, 4 and 5. The function was signifi cantly improved for all the preoperative Bland grades. On the nerve electrophysiological study, there was statistical improvement of the distal motor latency of the motor nerve and the nerve conduction velocity and amplitude of the sensory nerve. When the preoperative Bland grade was 2, 3, 4, 5 and 6, the extent of improved grade was 0.60, 0.75, 2.17, 2.87 and 4.25, respectively, at the long-term follow-up, and the Bland grade was signifi cantly improved when the preoperative Bland grade was 3, 4, 5 and 6. However, there was no statistical signifi cance between the Bland grade and the clinical state at the long-term follow-up.

Conclusion

The clinical and nerve electrophysiological states were significantly improved at the long-term follow-up after endoscopic carpal tunnel release. When the preoperative Bland grade was 3, 4 and 5, the clinical symptoms, function and the nerve electrophysiological states were signifi cantly improved at the long-term follow-up.

Keywords: idiopathic carpal tunnel syndrome, endoscopic carpal tunnel release, long-term follow-up outcomes, Boston carpal tunnel questionnaire, Bland grade

Figures and Tables

Table 1

Clinical Outcomes of Endoscopic Carpal Tunnel Release

Table 2

Electrophysiological Outcome of Endoscopic Carpal Tunnel Release

Table 3

Nerve Conduction Parameter before Surgery and Last Follow-up with Respective Statistical Differences

SD, standard deviation; DL, distal latency; NCV, nerve conduction velocity; Amp, amplitude.

Table 4

Boston Carpal Tunnel Score of Preoperative vs Last Follow-up

Table 5

Cases of Absence of Sensory NCV before Surgery

NCV, nerve conduction velocity; M, male; F, female; Rt., right; Lt., left.

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