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Impact of carpal tunnel surgery according to pre-operative abnormality of sensory conduction in median nerve: a longitudinal study

Impact of carpal tunnel surgery according to pre-operative abnormality of sensory conduction in median nerve: a longitudinal study
Impact of carpal tunnel surgery according to pre-operative abnormality of sensory conduction in median nerve: a longitudinal study
Background: we have previously proposed that sensory nerve conduction (SNC) in the median nerve should be classed as abnormal when the difference between conduction velocities in the little and index fingers is > 8 m/s. In a prospective longitudinal study, we investigated whether this case definition distinguished patients who were more likely to benefit from surgical treatment.

Methods: we followed up 394 patients (response rate 56%), who were investigated by a neurophysiology service for suspected carpal tunnel syndrome. Information about symptoms, treatment and other possible determinants of outcome was obtained through questionnaires at baseline and after follow-up for a mean of 19.2 months. Analysis focused on 656 hands with numbness, tingling or pain at baseline. Associations of surgical treatment with resolution of symptoms were assessed by Poisson regression, and summarised by prevalence rate ratios (PRRs) and associated 95% confidence intervals (95% CIs).

Results: during follow-up, 154 hands (23%) were treated surgically, and sensory symptoms resolved in 241 hands (37%). In hands with abnormal median SNC, surgery was associated with resolution of numbness, tingling and pain (PRR 1.5, 95% CI 1.0-2.2), and of numbness and tingling specifically (PRR 1.8, 95% CI 1.3-2.6). In contrast, no association was apparent for either outcome when median SNC was classed as normal.

Conclusions: our definition of abnormal median SNC distinguished a subset of patients who appeared to benefit from surgical treatment. This predictive capacity gives further support to its validity as a diagnostic criterion in epidemiological research.
241
Coggon, D.
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Ntani, G.
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Harris, E.C.
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Linaker, C.
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van der Star, R.
6ca52554-5a51-4fdc-bc62-dbb10389b018
Cooper, C.
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Palmer, K.T.
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Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Ntani, G.
9b009e0a-5ab2-4c6e-a9fd-15a601e92be5
Harris, E.C.
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Linaker, C.
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van der Star, R.
6ca52554-5a51-4fdc-bc62-dbb10389b018
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Palmer, K.T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850

Coggon, D., Ntani, G., Harris, E.C., Linaker, C., van der Star, R., Cooper, C. and Palmer, K.T. (2013) Impact of carpal tunnel surgery according to pre-operative abnormality of sensory conduction in median nerve: a longitudinal study. BMC Musculoskeletal Disorders, 14, 241. (doi:10.1186/1471-2474-14-241). (PMID:23947746)

Record type: Article

Abstract

Background: we have previously proposed that sensory nerve conduction (SNC) in the median nerve should be classed as abnormal when the difference between conduction velocities in the little and index fingers is > 8 m/s. In a prospective longitudinal study, we investigated whether this case definition distinguished patients who were more likely to benefit from surgical treatment.

Methods: we followed up 394 patients (response rate 56%), who were investigated by a neurophysiology service for suspected carpal tunnel syndrome. Information about symptoms, treatment and other possible determinants of outcome was obtained through questionnaires at baseline and after follow-up for a mean of 19.2 months. Analysis focused on 656 hands with numbness, tingling or pain at baseline. Associations of surgical treatment with resolution of symptoms were assessed by Poisson regression, and summarised by prevalence rate ratios (PRRs) and associated 95% confidence intervals (95% CIs).

Results: during follow-up, 154 hands (23%) were treated surgically, and sensory symptoms resolved in 241 hands (37%). In hands with abnormal median SNC, surgery was associated with resolution of numbness, tingling and pain (PRR 1.5, 95% CI 1.0-2.2), and of numbness and tingling specifically (PRR 1.8, 95% CI 1.3-2.6). In contrast, no association was apparent for either outcome when median SNC was classed as normal.

Conclusions: our definition of abnormal median SNC distinguished a subset of patients who appeared to benefit from surgical treatment. This predictive capacity gives further support to its validity as a diagnostic criterion in epidemiological research.

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Published date: 15 August 2013
Organisations: Faculty of Medicine

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Local EPrints ID: 359296
URI: http://eprints.soton.ac.uk/id/eprint/359296
PURE UUID: 2a63c3ea-cf5d-4f6d-8585-516aa7627703
ORCID for D. Coggon: ORCID iD orcid.org/0000-0003-1930-3987
ORCID for E.C. Harris: ORCID iD orcid.org/0000-0001-8037-566X
ORCID for C. Linaker: ORCID iD orcid.org/0000-0003-1091-9283
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 25 Oct 2013 12:56
Last modified: 18 Feb 2021 16:48

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Contributors

Author: D. Coggon ORCID iD
Author: G. Ntani
Author: E.C. Harris ORCID iD
Author: C. Linaker ORCID iD
Author: R. van der Star
Author: C. Cooper ORCID iD
Author: K.T. Palmer

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