Results of surgical treatment of carpal tunnel syndrome.

Background: The method of carpal tunnel syndrome (CTS) treatment depends on the severity of the symptoms. It is generally accepted that patients with mild and moderate CTS may be referred for conservative treatment while surgical treatment is recommended in patients with severe symptoms. The conclusions drawn on the basis of our study results should facilitate predicting treatment outcomes in patients with various degrees of disturbance in median nerve conduction and the severity of accompanying symptoms. They should also help in making the decision to operate or institute conservative treatment. The aim of this study was to assess sensory impairment as well as treatment efficacy in carpal tunnel syndrome depending on the degree of symptom severity and conduction disturbances.

Material And Methods: Surgical procedures were performed by several neurosurgeons from the same department using the same surgical method. The program of early postoperative rehabilitation was implemented and monitored by one person, the first author of this paper. The study had a prospective design. Treatment efficacy was evaluated by assessing changes in sensory excitability threshold by pulsed current, time to onset of paraesthesia in challenge tests, and scores in two subjective symptom severity scales: the Symptom Severity Scale and Functional Status Scale (Hand). The study participants were divided into several subgroups which differed in terms of carpal tunnel syndrome severity: the degree of symptom severity and the severity of conduction disturbances.

Results: A statistically significant difference was confirmed in the final threshold of sensation in the pulps of fingers I-III. It was found in the patients with mild and severe as well as moderate and severe conduction disturbances. A statistically significant difference in the degree of postoperative improvement measured with the SSS and FSS was confirmed between the groups with mild and severe conduction disturbances. After treatment completion, the lowest symptom severity (measured with SSS and FSS) was found in the patients who had reported mild symptoms before the surgery (difference among the groups was statistically significant). The difference in the degree of improvement after treatment between the groups was statistically significant. The largest improvement was confirmed in the patients with severe baseline symptoms and included the SSS and FSS scores as well as the time to onset of paraesthesia in challenge tests.

Conclusions: 1. Surgical treatment and early postoperative rehabilitation reduce subjective symptom severity, improve functional status of the hand, decrease superficial sensory disturbances on the pulps of fingers I-III and decrease median nerve responses to challenge tests. 2. The lower the severity of baseline conduction disturbances, the better the sensory function of the hand after treatment. 3. The improvement in subjective symptom severity and functional status is most marked in the patients with severe baseline conduction disturbances in the median nerve. 4. The best clinical condition after treatment (symptom severity, functional status) was found in the patients with mild CTS.