Surgery vs conservative therapy in carpal tunnel syndrome in people 70 +

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Plast Reconstr Surg. 2006 Sep 15;118(4):947-58; discussion 959-60.

Surgery versus conservative therapy in carpal tunnel syndrome in

people aged 70 years and older.

Ettema AM, Amadio PC, Cha SS, Harrington JR, AM, Offord KP.

Biomechanics Laboratory, Division of Orthopedic Research, Mayo

Clinic, Rochester, Minn., USA.

BACKGROUND: Carpal tunnel syndrome is common in the general

population, with a prevalence that increases with age. Although good

satisfaction has been described after carpal tunnel release, little

is known about the long-term outcome of treatment in elderly

individuals with carpal tunnel syndrome.

METHODS: The authors reviewed data from a population-based sample of

102 patients aged 70 years and older with carpal tunnel syndrome.

They used valid and sensitive mailed follow-up outcome [boston Carpal

Tunnel, satisfaction (American Academy of Orthopaedic Surgeons), and

health status (Short Form-36) questionnaires to assess symptoms,

functional status, expectations of treatment, and satisfaction with

the results at a minimum of 2 years after initial diagnosis.

RESULTS: Seventy patients with a mean age of 77.0 years (range, 70.2

to 88.5 years) responded to the survey, with a mean follow-up of 4.8

years. Patients who had surgery were more likely to have had more

severe disease than those treated nonoperatively (Mantel-Haentzel

test, p < 0.001).Satisfaction was 93 percent after surgical treatment

and 54 percent after nonsurgical treatment. Patients who had surgery

had significantly better relief of symptoms (t test, p < 0.01),

functional status (t test, p < 0.05), satisfaction (t test, p <

0.001), and expectations with treatment (t test, p < 0.05) scores as

compared with those who had nonsurgical treatment.

CONCLUSIONS: In patients over the age of 70, surgery appears to be

associated with better symptom relief, functional status,

satisfaction, and expectations with treatment than nonoperative

therapy does. Age should not be considered a contraindication for

carpal tunnel surgery, nor should nonoperative therapy be favored in

this age group.