Sonographic follow-up of patients with carpal tunnel syndrome undergoing surgical or nonsurgical treatment: prospective cohort study

Vögelin, Esther; Nüesch, Eveline; Jüni, Peter; Reichenbach, Stephan; Eser, Prisca; Ziswiler, Hans-Rudolf (2010). Sonographic follow-up of patients with carpal tunnel syndrome undergoing surgical or nonsurgical treatment: prospective cohort study. Journal of hand surgery - American volume, 35(9), pp. 1401-1409. Philadelphia, Pa.: Elsevier 10.1016/j.jhsa.2010.06.010

[img] Text
Vögelin JHandSurg 2010.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (521kB) | Request a copy

Purpose To compare changes in the largest cross-sectional area (CSA) of the median nerve in wrists undergoing surgical decompression with changes in wrists undergoing non-surgical treatment of carpal tunnel syndrome (CTS). Methods This study was a prospective cohort study in 55 consecutive patients with 78 wrists with established CTS, including 60 wrists treated with surgical decompression and 18 wrists with non-surgical treatment. A sonographic examination was scheduled before and 4 months after initiation of treatment. We compared changes in CSA of the median nerve between wrists with surgical treatment and wrists with non-surgical treatment using linear regression models. Results Decreases in CSA of the median nerve were more pronounced in wrists with CTS release than in wrists undergoing nonsurgical treatment (difference in means, 1.0 mm2; 95% confidence interval, 0.3–1.8 mm2). Results were robust to the adjustment for age, gender, and neurological severity at baseline. Among wrists with CTS release, those with postoperative CSA of 10 mm2 or less tended to have better clinical outcomes than those with postoperative CSA of greater than 10 mm2 (p=.055). Postoperative sonographic workup in the 3 patients with unfavorable outcome or recurrence identified likely causes for treatment failure in 2 patients. Conclusions In this observational study, surgical decompression was associated with a greater decrease in median nerve CSA than was nonsurgical treatment. Smaller postoperative CSAs may be associated with better clinical outcomes. Additional randomized trials are necessary to determine the optimal treatment strategy in different subgroups of patients with CTS. Type of study/level of evidence Therapeutic III.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Hand Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology

UniBE Contributor:

Vögelin, Esther; Nüesch, Eveline; Jüni, Peter; Reichenbach, Stephan; Eser, Prisca and Ziswiler, Hans Rudolf

ISSN:

0363-5023

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:09

Last Modified:

08 Sep 2015 14:47

Publisher DOI:

10.1016/j.jhsa.2010.06.010

PubMed ID:

20807617

Web of Science ID:

000281526400001

BORIS DOI:

10.7892/boris.1157

URI:

https://boris.unibe.ch/id/eprint/1157 (FactScience: 202013)

Actions (login required)

Edit item Edit item
Provide Feedback