Effect Observation between Surgical and Pharmaceutical Management of Carpal Tunnel Syndrome

— Background : There is no global approval on the efficiency and safety of different modalities for carpal tunnel syndrome management. Various minimally invasive methods were suggested to reduce morbidity. Nevertheless, the risk of neurovascular insult and failure still exist. Aim : To observe the outcome effect of carpal tunnel syndrome managed with mini-open limited incision release of the transverse carpal ligament and the outcome of carpal tunnel syndrome managed with local injection of Methyl prednisolone in the carpal tunnel. Methods : Our prospective, randomized and double blind investigation included 126 patients, of both sexes, aged 26-67 years and diagnosed of unilateral idiopathic carpal tunnel syndrome using clinical (objective and subjective) and electrophysiological study ( a non-recordable distal sensory latency of the median nerve) at Prince Hashim military hospital, Zarqa, JORDAN, during the period Feb 2014-Nov 2017. Patients in group S (n= 62,median age of 57 yr) were scheduled to open longitudinal mini-limited incision (2 cm) in line with the fourth ray, extending to but not crossing the distal wrist crease with release and dividing the transverse carpal ligament. Patients in group M (n= 64, median age of 41 yr) were scheduled to local injection of methyl prednisolone 40 mg in the carpal tunnel. The needle of the syringe is placed at the anterior wrist flexion crease at a 30-degree angle and slowly advanced until the tip is just beyond the tendon of the palmaris longus. Patient-symptom intensity and functional status outcomes were evaluated using Boston Carpal Tunnel Questionnaires. Safety is measured by the need for second surgery, while efficiency is measured by the Symptom Severity Scale (SSS) (11 items) and the Functional Status Scale (FSS) (eight items) of the Boston Carpal Tunnel Syndrome Questionnaire. Failed surgery was defined if clinical features remained after surgery or there was a need for a second surgery. Outcome was stratified into full clinical feature recovery, partial or no clinical feature recovery at 12 months after local injection. All patients with history of local trauma, local steroid injection, bilateral carpal tunnel syndrome, carpal tunnel release or a diagnosis of peripheral neuropathy were ruled out. For normality, data was analyzed using the Kolmogorov–Smirnoff test. Spearman’s rho correlation coefficient (r) was used for evaluating correlations between continuous parameters. All P-values less than 0.05 were considered statistically significant. Results : Boston Carpal Tunnel Questionnaires in group S showed a clinical feature intensity score of 13.4 and a functional status score of 10.2. One patient in group S (1.6%) needed revision surgery after 2 years. In group M, at 1 year, only 18 (28.1%) patients had full recovery of clinical features. Conclusion : The Mini-open limited incision release surgical modality was an efficient option for carpal tunnel syndrome management in recovering clinical features and regaining functionality. Local injection of Methyl prednisolone may delay surgery for carpal tunnel syndrome and it is advised to start with local corticosteroid injection when managing carpal tunnel syndrome before surgery.