Endoscopic Carpal Tunnel Release in the Elderly

Abstract

The present study is aimed to clarify the postoperative outcome of endoscopic carpal tunnel release in elderly patients with carpal tunnel syndrome. Endoscopic carpal tunnel release was performed on 37 hands of 27 patients (2 men, 25 women) who were aged 70 years or older and clinically and electrophysiologically diagnosed with carpal tunnel syndrome. Mean age at the time of surgery was 74.5 years (range: 70-85 years). Mean postoperative follow-up was 35.5 months (range: 12-114 months). Pain was present preoperatively in 20 hands, but quickly resolved postoperatively in all cases. Numbness completely disappeared in 13 of 37 hands (35.1%), but some degree of numbness remained in the remaining cases. Preoperative severity of thenar muscle atrophy was none in 4 hands, mild in 7 hands, moderate in 12 hands and severe in 14 hands. Postoperative severity of thenar muscle atrophy at final follow-up was none in 13 hands, mild in 16 hands, moderate in 2 hands and severe in 6 hands, confirming that thenar muscle atrophy improves even in elderly patients. However, moderate or severe thenar muscle atrophy remained in 8 hands (21.6%). Endoscopic carpal tunnel release should be considered in the elderly, even though clinical symptoms may not improve substantially in advanced cases.

Carpal tunnel syndrome - entrapment neuropathy - endoscopic carpal tunnel release - elderly patients

References

• 1 Hybbinette CH, Mannerfelt L. The carpal tunnel syndrome. A retrospective study of 400 operated patients.  Acta Orthop Scand. 1975;  46 610-620
• 2 Padua L, Padua R, Aprile, Tonali P. Italian multicentre study of carpal tunnel syndrome. Differences in the clinical and neurophysiological features between male and female patients.  J Hand Surg [Br]. 1999;  24 579-582
• 3 Phalen GS. The carpal-tunnel syndrome. Clinical evaluation of 598 hands.  Clin Orthop Relat Res. 1972;  83 29-40
• 4 Bodofsky EB, Campellone JV, Wu KD, Greenberg WM. Age and the severity of carpal tunnel syndrome.  Electromyogr Clin Neurophysiol. 2004;  44 195-199
• 5 Seror P. Carpal tunnel syndrome in the elderly. “Beware of severe cases”.  Ann Chir Main Memb Super. 1991;  10 217-225
• 6 Todnem K, Lundemo G. Median nerve recovery in carpal tunnel syndrome.  Muscle Nerve. 2000;  23 1555-1560
• 7 Tomaino MM, Weiser RW. Carpal tunnel release for advanced disease in patients 70 years and older: does outcome from the patient's perspective justify surgery?.  J Hand Surg [Br]. 2001;  26 481-483
• 8 Porter P, Venkateswaran B, Stephenson H, Wray CC. The influence of age on outcome after operation for the carpal tunnel syndrome. A prospective study.  J Bone Joint Surg [Br]. 2002;  84 688-691
• 9 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
• 10 Mondelli M, Padua L, Reale F. Carpal tunnel syndrome in elderly patients: results of surgical decompression.  J Peripher Nerv Syst. 2004;  9 168-176
• 11 Townshend DN, Taylor PK, Gwynne-Jones DP. The outcome of carpal tunnel decompression in elderly patients.  J Hand Surg [Am]. 2005;  30 500-505
• 12 Weber RA, Rude MJ. Clinical outcomes of carpal tunnel release in patients 65 and older.  J Hand Surg [Am]. 2005;  30 75-80
• 13 Chow JC. Endoscopic release of the carpal ligament for carpal tunnel syndrome: 22-month clinical result.  Arthroscopy. 1990;  6 288-296
• 14 Rosen B, Lundborg G, Abrahamsson SO, Hagberg L, Rosen I. Sensory function after median nerve decompression in carpal tunnel syndrome. Preoperative vs postoperative findings.  J Hand Surg [Br]. 1997;  22 602-606
• 15 American Orthopaedic Association .Manual of Orthopaedic Surgery. Chicago: American Orthopaedic Association 1979: 27-31
• 16 Stevens JC, Sun S, Beard CM, O'Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980.  Neurology. 1988;  38 134-138
• 17 Nagaoka M, Nagao S, Matsuzaki H. Endoscopic release for carpal tunnel syndrome accompanied by thenar muscle atrophy.  Arthroscopy. 2004;  20 848-850
• 18 Florack TM, Miller RJ, Pellegrini VD, Burton RI, Dunn MG. The prevalence of carpal tunnel syndrome in patients with basal joint arthritis of the thumb.  J Hand Surg [Am]. 1992;  17 624-630
• 19 Melone Jr. CP, Beavers B, Isani A. The basal joint pain syndrome.  Clin Orthop Relat Res. 1987;  220 58-67

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