title: The benefit of carpal tunnel release in patients with electrophysiologically moderate and severe disease.
abstract: OBJECTIVE
  To compare change in numbness and pain after carpal tunnel release in patients with electrophysiologically moderate and severe disease.
  
  
  METHODS
  We tested the primary null hypothesis that there is no difference in the total Carpal Tunnel Symptoms Scale score 3 months after surgery between patients with moderate and those with severe disease. Ninety-five patients (47 in the moderate cohort, and 48 in the severe cohort) who had miniopen carpal tunnel release between November 2011 and November 2013 were identified from our prospectively collected database. For each patient, the total Carpal Tunnel Symptoms Scale score, as well the numbness and pain subscale scores, at the preoperative and postoperative (2-wk, 1-mo, 2-mo, 3-mo, ≥ 1-y) visits were documented. The data were analyzed with repeated-measures analysis of variance.
  
  
  RESULTS
  Three months after surgery, patients with moderate carpal tunnel syndrome (CTS) reported, on average, no symptoms, and patients with severe disease had reduced but unresolved symptoms. Although symptoms diminished in both groups from the preoperative assessment to the 2-week postoperative assessment, patients with severe CTS had comparatively more severe symptoms at all time points with the exception of pain at 2 weeks and 1 year or longer after surgery, at which times there was no significant difference. At 1 year or longer after surgery, 1 (2%) patient with moderate CTS and 9 (19%) patients with severe CTS reported continued symptoms. Preoperative electrodiagnostic severity was the factor most predictive of symptom scores.
  
  
  CONCLUSIONS
  Patients with severe CTS experience considerable reduction in symptoms after surgery but should be informed that recovery may be more prolonged and, in some cases, incomplete 1 year after carpal tunnel release, particularly with regard to numbness.
  
  
  METHODS
  Prognostic III.
authors.affiliation: The Andrews Institute, Gulf Breeze, FL; Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: skronlage@yahoo.com.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Kronlage
authors.affiliation: The Andrews Institute, Gulf Breeze, FL; Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carpal tunnel; benefit; electrodiagnostic; moderate; release; severe