Changes in the Hand Strength and Related Factors after Carpal Tunnel Decompression

Youn Moo Heo; Jae Young Roh; Sang Bum Kim; Jin Woong Yi; Kwang Kyoun Kim; Jung Bum Lee; Dong Sik Chae

doi:10.4055/jkoa.2011.46.2.99

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Heo, Roh, Kim, Yi, Kim, Lee, and Chae: Changes in the Hand Strength and Related Factors after Carpal Tunnel Decompression

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(2): 99-106.

Published online: 22 April 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.2.99

Changes in the Hand Strength and Related Factors after Carpal Tunnel Decompression

Youn Moo Heo, M.D., Jae Young Roh, M.D., Sang Bum Kim, M.D., Jin Woong Yi, M.D., Kwang Kyoun Kim, M.D., Jung Bum Lee, M.D., Dong Sik Chae, M.D.

Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.

Correspondence to: Kwang Kyoun Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Konyang University Hospital, 685, Gasoowon-dong, Seo-gu, Daejeon 302-718, Korea. TEL: +82-42-600-6902 or 9120, FAX: +82-42-545-2373, ajouos@hanmail.net

Received 29 March 2010 Accepted 16 January 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

Our goal was to investigate an improvement in hand strength and its associated factors after carpal tunnel decompression in patients with carpal tunnel syndrome.

Materials and Methods

Between January 2008 and January 2009, a total of 31 patients (50 hands) treated with carpal tunnel decompression for carpal tunnel syndrome were enrolled into the study. Hand-strength was assessed pre- and post-surgery. In the pre-operation evaluation, we assessed multiple factors and investigated the association between these factors and recovery of hand strength.

Results

All patients regained hand strength after surgery. On average, the grip strength was 14.8 kg preoperatively, 13.0 kg at 6 weeks, 16.2 kg at 3 months, 18.7 kg at 6 months, and 20.6 kg at 1year postoperatively. The tip-pinch strength was 3.4 kg preoperatively and improved to 3.9 kg at 6 weeks, 4.0 kg at 3 months, 4.4 kg at 6 months and 4.7 kg at 1 year postoperatively. The key-pinch strength showed same pattern of improvement. The recovery of grip strength was significantly slower in patients with longer duration of carpal tunnel syndrome, with diabetes, or with nocturnal pain. There was no factor affecting the recovery of tip-pinch strength. Recovery of key-pinch strength was slower in patients that had experienced a longer duration of symptoms.

Conclusion

Grip strength and pinch strength were recovered within 3 months and 6 weeks, respectively, after carpal tunnel decompression; both improved gradually until 12 months after surgery. Disease duration, diabetes, and nocturnal pain were significant factors that impacted on post-surgery recovery.

Keywords: median nerve, carpal tunnel syndrome, carpal tunnel decompression, hand strength, grip strength, pinch strength

Figures and Tables

Table 1

Changes in Hand Strength (kg)

Table 2

The Factors Related with Grip Strength Changes and Overall Results

DM, diabetes; HTN, hypertension.

Table 3

The Factors Related with Tip-Pinch Changes and Overall Results

DM, diabetes; HTN, hypertension.

Table 4

The Factors Related with Key-Pinch Changes and Overall Results

DM, diabetes; HTN, hypertension.

References

1. Geere J, Chester R, Kale S, Jerosch-Herold C. Power grip, pinch grip, manual muscle testing or thenar atrophy - which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review. BMC Musculoskelet Disord. 2007. 8:114.

2. Kluge W, Simpson RG, Nicol AC. Late complications after open carpal tunnel decompression. J Hand Surg Br. 1996. 21:205–207.

3. Kozin SH, Pagnanelli DM. Grip strength after carpal tunnel release: role of the transverse caxpal ligament. Am J Orthop (Belle Mead NJ). 2002. 31:571–574.

4. Leach WJ, Esler C, Scott TD. Grip strength following carpal tunnel decompression. J Hand Surg Br. 1993. 18:750–752.

5. Mathur K, Pynsent PB, Vohra SB, Thomas B, Deshmukh SC. Effect of wrist position on power grip and key pinch strength following carpal tunnel decompression. J Hand Surg Br. 2004. 29:390–392.

6. Amadio PC, Silverstein MD, Ilstrup DM, Schleck CD, Jensen LM. Outcome assessment for carpal tunnel surgery: the relative responsiveness of generic, arthritis-specific, disease-specific, and physical examination measures. J Hand Surg Am. 1996. 21:338–346.

7. Wong KC, Hung LK, Ho PC, Wong JM. Carpal tunnel release. A prospective, randomised study of endoscopic versus limited-open methods. J Bone Joint Surg Br. 2003. 85:863–868.

8. Olsen KM, Knudson DV. Change in strength and dexterity after open carpal tunnel release. Int J Sports Med. 2001. 22:301–303.

9. Helm RH, Vaziri S. Evaluation of carpal tunnel release using the Knifelight instrument. J Hand Surg Br. 2003. 28:251–254.

10. Cresswell TR, Heras-Palou C, Bradley MJ, et al. Long-term outcome after carpal tunnel decompression - a prospective randomised study of the Indiana Tome and a standard limited palmar incision. J Hand Surg Eur Vol. 2008. 33:332–336.

11. Gellman H, Kan D, Gee V, Kuschner SH, Botte MJ. Analysis of pinch and grip strength after carpal tunnel release. J Hand Surg Am. 1989. 14:863–864.

12. Mackenzie DJ, Hainer R, Wheatley MJ. Early recovery after endoscopic vs. short-incision open carpal tunnel release. Ann Plast Surg. 2000. 44:601–604.

13. Wilgis EF, Burke FD, Dubin NH, Sinha S, Bradley MJ. A prospective assessment of carpal tunnel surgery with respect to age. J Hand Surg Br. 2006. 31:401–406.

14. Weber RA, Rude MJ. Clinical outcomes of carpal tunnel release in patients 65 and older. J Hand Surg Am. 2005. 30:75–80.

15. Leit ME, Weiser RW, Tomaino MM. Patient-reported outcome after carpal tunnel release for advanced disease: a prospective and longitudinal assessment in patients older than age 70. J Hand Surg Am. 2004. 29:379–383.

16. Das SK, Brown HG. In search of complications in carpal tunnel decompression. Hand. 1976. 8:243–249.

17. Netscher D, Steadman AK, Thornby J, Cohen V. Temporal changes in grip and pinch strength after open carpal tunnel release and the effect of ligament reconstruction. J Hand Surg Am. 1998. 23:48–54.

18. Gartsman GM, Kovach JC, Crouch CC, Noble PC, Bennett JB. Carpal arch alteration after carpal tunnel release. J Hand Surg Am. 1986. 11:372–374.

19. Westbrook AP, Tredgett MW, Davis TR, Oni JA. The rapid exchange grip strength test and the detection of submaximal grip effort. J Hand Surg Am. 2002. 27:329–333.

20. Young VL, Logan SE, Fernando B, Grasse P, Seaton M, Young AE. Grip strength before and after carpal tunnel decompression. South Med J. 1992. 85:897–900.

21. Unglaub F, Wolf E, Goldbach C, Hahn P, Kroeber MW. Subjective and functional outcome after revision surgery in carpal tunnel syndrome. Arch Orthop Trauma Surg. 2008. 128:931–936.

22. Zyluk A, Strychar J. A comparison of two limited open techniques for carpal tunnel release. J Hand Surg Br. 2006. 31:466–472.

23. Pomerance J, Fine I. Outcomes of carpal tunnel surgery with and without supervised postoperative therapy. J Hand Surg Am. 2007. 32:1159–1163.

24. Hobby JL, Venkatesh R, Motkur P. The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome. J Hand Surg Br. 2005. 30:599–604.

25. Burke FD, Wilgis EF, Dubin NH, Bradley MJ, Sinha S. Relationship between the duration and severity of symptoms and the outcome of carpal tunnel surgery. J Hand Surg Am. 2006. 31:1478–1482.

26. DeStefano F, Nordstrom DL, Vierkant RA. Long-term symptom outcomes of carpal tunnel syndrome and its treatment. J Hand Surg Am. 1997. 22:200–210.

27. Park SW, Goodpaster BH, Strotmeyer ES, et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes. 2006. 55:1813–1818.

28. Cetinus E, Buyukbese MA, Uzel M, Ekerbicer H, Karaoguz A. Hand grip strength in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2005. 70:278–286.

29. Thomsen NO, Cederlund R, Rosén I, Björk J, Dahlin LB. Clinical outcomes of surgical release among diabetic patients with carpal tunnel syndrome: prospective follow-up with matched controls. J Hand Surg Am. 2009. 34:1177–1187.

30. Katz JN, Losina E, Amick BC 3rd, Fossel AH, Bessette L, Keller RB. Predictors of outcomes of carpal tunnel release. Arthritis Rheum. 2001. 44:1184–1193.

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