Prognostic value of electrodiagnostic assessment in cases of carpal tunnel syndrome

الملخص EN

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy.

Electro diagnostic assessment is already established as an important diagnostic tool for this condition.

Meanwhile, it is an area of a big debate if this assessment has any role in predicting treatment outcome and if we can use it in taking treatment decision.

Aim of Study : determination of the role of electro diagnostic assessment in determining the best line of treatment and if it has any role in predicting treatment response.

Methodology : Ninety-seven patients presenting with symptoms and having signs of CTS were recruited.

Initial assessment included both clinical and electrophysiological means that consisted of combined motor and sensory studies.

The patients were managed according to their preferences as conservative with splinting and local steroid injection or surgical by open carpal tunnel release.

They were followed up at 4-6 months and after 10-12 months after treatment.

After drop outs, we followed 75 hands treated conservatively and 36 hands treated surgically.

Results : we found that patients, in general, had better response to surgical intervention than conservative treatment with long-term satisfaction from surgery of 75 % relative to 56 % in the conservative group.

This difference was less marked in the short-term results with both treatments giving nearly the same outcome.

Testing for treatment response after stratification of the patients into different grades of neurophysiologic severity, we found that conservative treatment failed to satisfy the more severe grades of nerve affection while surgery remained effective both in short term or long term results.

The rate of recurrence in severe cases reached 60 % after the first 4-6 months of treatment in patients with severe neurophysiologic assessment results.

Also, there was an objective improvement in both motor and sensory latencies after surgical treatment, a response that failed to occur with conservative treatment.

Some mild cases with < 25 % of delay in motor or sensory latencies returned to normal figures after surgery with most of the latency improvement occurred in the first 4-6 months.

Using multiple stepwise logistic regression, we found that the electro diagnostic grade, duration of complaint and its severity had a significant predicting value in determining treatment response.

Conclusion : Electro diagnostic assessment is an important tool in determining treatment options for CTS patients.

It is a good tool to follow up the condition.

And can help in making realistic expectations from treatment.