Elderly patients may retain disability following carpal tunnel surgery

Friday, March 24, 2006

JACKSONVILLE, Fla. — Hand and Microvascular surgeons at Mayo Clinic in Jacksonville say that while results of surgery for elderly patients with carpal tunnel syndrome are good or excellent in most cases, some elderly patients will continue to experience persistent disability from carpal tunnel syndrome following surgery. However, factors such as arthritis, diabetic peripheral neuropathy and cognitive dysfunction may also play a role in the elderly patient's perceived level of post-operative disability.

Carpal tunnel syndrome can cause pain, weakness, numbness or tingling in the hand and wrist. These symptoms occur when the median nerve in the wrist is compressed for any reason. Repetitive use, stress or trauma to the wrist is frequently blamed for the condition, according to Mayo Clinic hand surgeon, Dr. Peter Murray. "The majority of carpal tunnel syndrome is what we call idiopathic, which means we don't know what causes it," he says. "Although repetitive hand activity may play a role, it's probably overstated."

Murray says wearing a wrist splint to relieve pressure if symptoms have been present for less than six months, or corticosteroid injections for symptoms present less than a year are usually effective treatments. If these do not provide relief or if symptoms have been present for a long time, Murray says patients may opt for a surgical procedure called carpal tunnel release.

During this outpatient procedure done under a local anesthetic, the surgeon makes an incision in the palm at the wrist and cuts through the carpal ligament to relieve pressure on the compressed median nerve. The incision can be done in one of two ways: an open incision or an endoscopic technique, which uses a tiny camera to see inside the carpal tunnel. With either technique, patients wear a bandage for about two weeks at which time the stitches are removed. Patients usually return to full activity in about four weeks.

"About 98 - 99 percent of people who have carpal tunnel release surgery say they're satisfied after several months, or even several weeks following surgery," Murray says. "But we see a large number of people who are over 75 years of age. And it became apparent to me that they don't do quite as well."

To test his hypothesis, Murray and his colleagues looked at 100 of their consecutive patients over age 75 that had open carpal tunnel release surgery. Of those 100, 69 patients who had a total of 81 open carpal tunnel release surgeries participated in a study. (Some had the surgery on both hands.) Using two metrics that evaluated objective and subjective measures of post-operative disability, Murray found that 16 percent of the wrists operated on continued to exhibit disability. "Primarily these patients' overall satisfaction with the procedure was less," Murray says. "Their ability to feel tactile sensation was not as good. Their grip strength and overall functionality of their hand wasn't quite as good as we would have liked."

Murray says results of the study do not indicate elderly patients should be ruled out for the surgery. He says doctors should, however, make sure their elderly patients have realistic expectations. "I think when you get to the point that surgery is considered, you have to be very frank and tell them there's the chance that their symptoms may not get better, and there's a chance that if they do, it may take a long time."

In conclusion, Murray says elderly patients with carpal tunnel syndrome may have other conditions such as arthritis in the wrist or neck, neuropathy brought on by diabetes or thyroid disease that can cause similar symptoms. These patients, who may also have a level of cognitive decline, may mistakenly perceive their symptoms have not improved following carpal tunnel release surgery. Doctors should discuss all these factors with the patient and family before surgery.

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