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CC BY-NC-ND 4.0 · Indian J Plast Surg 2017; 50(03): 260-265
DOI: 10.4103/ijps.IJPS_41_17
Original Article
Association of Plastic Surgeons of India

A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery

Sushil Ramesh Nehete
Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
,
Binita B. Raut
Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
,
Amita S. Hiremath
Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
,
R. Mukund Thatte
Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
› Author Affiliations
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Publication History

Publication Date:
10 July 2019 (online)

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ABSTRACT

Objective: We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery. Patients and Methods: A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively. Results: Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05). Conclusions: Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.

KEY WORDS

Carpal tunnel syndrome - disabilities of arm - shoulder and hand score - electromyography nerve conduction velocity - Levine score
 

  • REFERENCES

  • 1 Bickel KD. Carpal tunnel syndrome. J Hand Surg Am 2010; 35: 147-52
    CrossrefPubMedSearch in Google Scholar
  • 2 Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH. et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75: 1585-92
    CrossrefPubMedSearch in Google Scholar
  • 3 Simpson JA. Electrical signs in the diagnosis of carpal tunnel and related syndromes. J Neurol Neurosurg Psychiatry 1956; 19: 275-80
    CrossrefPubMedSearch in Google Scholar
  • 4 Gilliatt RW, Sears TA. Sensory nerve action potentials in patients with peripheral nerve lesions. J Neurol Neurosurg Psychiatry 1958; 21: 109-18
    CrossrefPubMedSearch in Google Scholar
  • 5 Available from: http://www.wongbakerfaces.org [Last accessed on 2017 Nov 25].
  • 6 Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 2003; 4: 11
    CrossrefPubMedSearch in Google Scholar
  • 7 Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. et al. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997; 96: 211-7
    PubMedSearch in Google Scholar
  • 8 El-Hajj T, Tohme R, Sawaya R. Changes in electrophysiological parameters after surgery for the carpal tunnel syndrome. J Clin Neurophysiol 2010; 27: 224-6
    CrossrefPubMedSearch in Google Scholar
  • 9 Thatte MR, Mansukhani KA. Compressive neuropathy in the upper limb. Indian J Plast Surg 2011; 44: 283-97
    CrossrefPubMedSearch in Google Scholar
  • 10 You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve 1999; 22: 497-501
    CrossrefPubMedSearch in Google Scholar
  • 11 Schrijver HM, Gerritsen AA, Strijers RL, Uitdehaag BM, Scholten RJ, de Vet HC. et al. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: Lessons from a randomized controlled trial. J Clin Neurophysiol 2005; 22: 216-21
    PubMedSearch in Google Scholar
  • 12 Longstaff L, Milner RH, O'Sullivan S, Fawcett P. Carpal tunnel syndrome: The correlation between outcome, symptoms and nerve conduction study findings. J Hand Surg Br 2001; 26: 475-80
    CrossrefPubMedSearch in Google Scholar
  • 13 Khan F, Shehna A, Ramesh S, Sandhya KS, Paul R. Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity. Ann Indian Acad Neurol 2017; 20: 69-72
    CrossrefPubMedSearch in Google Scholar