title: Electrophysiological assessment of carpal tunnel syndrome in elderly patients: one-year follow-up study.
abstract: OBJECTIVE
  To objectively assess elderly patients with carpal tunnel syndrome to characterize their preoperative severity and prognosis after carpal tunnel release using a electrophysiological severity scale.
  
  
  METHODS
  Electrophysiologic assessment was performed preoperatively and 1 year postoperatively following carpal tunnel release in 112 hands in patients over 70 years of age prospectively by the use of the following electrophysiological severity scale: stage 1, normal distal motor latency (DML) and normal sensory conduction velocity (SCV); stage 2, DML ≥ 4.5 milliseconds and normal SCV; stage 3, DML ≥ 4.5 milliseconds and SCV < 40.0 m/s; stage 4, DML ≥ 4.5 milliseconds and non-measurable SCV; stage 5; non-measurable DML and non-measurable SCV. Additionally, the outcomes of clinical symptoms of pain, nocturnal symptoms, numbness, loss of 2-point discrimination in the median nerve territory, and thenar atrophy were assessed.
  
  
  RESULTS
  The mean age of patients was 77 years at the time of the operation. Preoperatively, the most common severity was stage 5 (70 of 112 hands, 63%), and clustering stage 4 and 5 together as severe resulted in 103 hands (92%). One year postoperatively, 97 hands (87%) demonstrated at least one stage improvement, and the numbers of mild (stage 1 or 2) increased from 3 (3%) to 45 hands (40%). Parallel with the electrophysiological improvement, pain and nocturnal symptoms resolved in 17 of 17 hands and 11 of 11 hands, respectively, in whom they were present preoperatively. Numbness, loss of 2-point discrimination, and thenar atrophy demonstrated the improvement in 96 of 112 (86%) hands, in 58 of 112 (52%) hands, and in 80 of 96 (83%) hands.
  
  
  CONCLUSIONS
  We observed electrophysiologic improvement in 86% of elderly patients following carpal tunnel release. Electrophysiologic outcomes correlated with improvement in clinical variables.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan. Electronic address: takakokatie@kobeh.rofuku.go.jp.
authors.forename: Takako
authors.initials: T
authors.lastname: Kanatani
authors.affiliation: Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Nagura
authors.affiliation: Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
authors.affiliation: Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kokubu
authors.affiliation: Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Sumi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology*; D009431:Neural Conduction / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Elderly carpal tunnel syndrome; carpal tunnel release; electrophysiological assessment