Burke, F. D., Wilgis, E. F. S., Dubin, N. H., Bradley, M. J., & Sinha, S. (2006). Relationship between the duration and severity of symptoms and the outcome of carpal tunnel surgery. The Journal of Hand Surgery, 31A(9), 1478-1482.
The purpose of this study was to evaluate patients undergoing carpal tunnel surgery, before and after surgery, to determine if duration and severity of symptoms are related to outcomes. There is conflicting data on whether preoperative symptoms are predictive of symptom relief after surgery. The literature reports no consensus on the prognostic value of preoperative symptom severity and duration to determine the outcomes of carpal tunnel release. A survey of hand surgeons noted that 78 % used increased symptomatology as an indication for expeditious surgery. The rationale for such an approach is that "increased pressure within the carpal canal should lead to occlusion of intraneural vessels with subsequent neural ischemia" (p. 1478), leading one to conclude that more severe symptoms would have a poorer outcome if not operated on quickly. This article notes, however, that numerous studies refute that conclusion.
Seven hundred eighty patients were included in the study from two different sites over a 2-year period in the United Kingdom (N = 240) and the United States (N = 283). Criteria for study inclusion were: scheduled for carpal tunnel surgery on the basis of examination, between the ages of 20-90 years, spoke English, were willing to provide consent, and could participate in a postoperative evaluation. Exclusion criteria included previous carpal tunnel surgery in the affected hand, pregnancy, renal dialysis, acute peripheral neuropathy, or a terminal disease. The Levine-Katz self-assessment questionnaire, a validated tool, which measures the severity of 11 symptoms and eight activities of daily living of the patient with carpal tunnel symptoms, was used to determine symptom and function status. The scores range from 1-5, with 5 being the worst. The Levine-Katz tool was given preoperatively and at 6 months after surgery.
The results of the study indicated that the Levine-Katz symptom severity and functional status scores improved after surgery, despite the duration of symptoms. All patients showed improvement in symptom scores by the end of 6 months. There was no relationship between the duration of symptoms and outcomes. A bias factor might have been in the self-report of symptoms, where recall may be hard to determine for the duration of the symptoms. Patients who did have high severity scores initially had the greatest improvement but not to the level of those with mild initial scores. The patients with high Levine-Katz scores also demonstrated high symptom severity scores at 6 months, which can indicate that severity does have an effect on outcomes. They also found that duration of symptoms before surgery did not affect the outcome, as determined by the Levine-Katz self-report tool, even though those with high scores did not come down to the level of those with mild scores.
As orthopaedic nurses, we can advise patients that the severity of the symptoms rather than the duration of the symptoms has a greater effect on postoperative outcome.