Predicting If Carpal Tunnel Surgery Or Therapy Will Help 
Carpal Tunnel is a term we are all familiar with today. However, the standards for treatment are confusing. Several questions need answering before treatment can begin: 1.) Is it really Carpal Tunnel? Yes/No 2.) If it is Carpal Tunnel, how can we predict if surgery or therapy will help? 3.) Has anybody figured out number 1 and number 2? The first signs of a nerve compression are pins and needles in the hand (Illustration 2), and for Carpal Tunnel specifically the thumb, index, long, and one half ring finger. The patient may complain of clumsiness. Symptoms are usually aggravated by use of the hand grasping or pinching. If symptoms are aggravated by lifting, the compression site is usually higher up either in the forearm, shoulder, or neck. Pain or parethesia at night are common at first. Actual decreased sensation and weakness are signs of advanced nerve damage (Illustration 3). Unfortunately, many of our patients wait until this happens before they come to see us. Lets review, pins and needles and clumsiness are the early signs of nerve compression such as Carpal Tunnel. Advanced later signs include actual loss of sensation and weakness in the affected muscles. This means the patient now has permanent nerve damage with limited improvement likely. Electrodiagnostic testing can be helpful to separate Cervical problems from Carpal Tunnel Syndrome. However, (Braun and Jackson 1994) in a study of 151 patients showed that the correlation between electrodiagnostic and good outcomes of Carpal Tunnel Surgeries were actually quite poor. In other words, electrodiagnostic testing is a poor predictor of whether surgery or therapy will improve the patient’s functional status and reduce their complaints of pain. My view is that for common nerve problems, the high cost of the electrodiagnostic test, the pain associated with it, and the frequent lack of correlation between the patients symptoms and the test, are all reasons for physicians and therapists involved to get back to basics: Take a good history and really get it down. Do a careful physical examination. Obtain a low cost quantitative sensorimotor test (we use the Pressure Specified Sensorimeter Device, PSSD). What is the PSSD (Pressure Specified Sensorimotor Device)? It (PSSD) is an extremely sensitive instrument that measures the slightest sensory loss before advanced nerve damage occurs. It also measures motor loss for grip and pinch, and for about one half the cost. With this device you can quantify nerve sensory loss before serious nerve damage occurs. This means you can improve prediction of whether therapy or surgery will have a successful outcome of decreased pain and increased function, such as ability to return to work. Bottom line is that the PSSD is a cost saving test that is sensitive enough to give a good prediction of actual level of nerve health. This information can tell you if your patient will do well after therapy or surgery. For a demonstration or a brochure with a CD-ROM demo you may call us toll free at 800-350-6839 or e-mail on line at www.tristatehand.com. Our website also has information on the device (PSSD). (Braun RM and Jackson W.J. Electrical Studies as a prognostic factor in the Surgical Treatment of Carpal Tunnel Syndrome. J of Hand Surgery 19A. 893-900, 1994.) |
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