Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
Clin Orthop Relat Res. 2022 Aug 1;480(8):1576-1581. doi: 10.1097/CORR.0000000000002115. Epub 2022 Jan 13.
Carpal tunnel release can stop the progression of idiopathic median neuropathy at the wrist (carpal tunnel syndrome). Intermittent symptoms tend to resolve after surgery, but loss of sensibility can be permanent. Both pathophysiology (severe neuropathy) and mental health (symptoms of despair or worry) contribute to problematic recovery after carpal tunnel release, but their relative associations are unclear.
QUESTION/PURPOSE: Is problematic initial recovery after carpal tunnel release associated with psychologic distress rather than with disease severity?
We retrospectively studied 156 patients who underwent in-office carpal tunnel release between November 2017 and February 2020, and we recorded their symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD]) and depression (Patient Health Questionnaire), signs of severe median neuropathy (loss of sensibility, thenar muscle atrophy, and palmar abduction weakness), and problematic recovery. The initial recovery (first 2 weeks) was categorized as problematic if the patient was upset about persistent numbness, experienced unsettling postoperative pain, developed hand stiffness, or experienced wound issues-all of which are routinely recorded in the medical record by the treating surgeon along with signs of severe median neuropathy. Twenty-four percent (38 of 156) of patients had a problematic initial recovery characterized by distress regarding persistent numbness (16% [25 of 156]), unsettling pain (8% [12 of 156]), hand stiffness (5% [8 of 156]), or wound issues (1% [2 of 156]); 6% (9 of 156) of patients had more than one issue. Associations between problematic initial recovery and age, gender, symptoms of anxiety and depression, disease severity, specific exam findings, and insurance were evaluated using t-tests, Mann-Whitney tests, and chi-square tests, with the plan to perform logistic regression if at least two variables had an association with p < 0.10.
The only factor associated with problematic initial recovery was greater symptoms of anxiety (median GAD score 1.5 [interquartile range 0 to 7.8] for problematic initial recovery compared with a median score of 0 [IQR 0 to 2] for nonproblematic recovery; p = 0.04), so we did not perform a logistic regression. Physical examination findings consistent with severe median neuropathy were not associated with problematic initial recovery.
The finding that problematic initial recovery after carpal tunnel release was related to symptoms of anxiety and not to the severity of median neuropathy highlights the need to study the ability of efforts to ameliorate anxiety symptoms before carpal tunnel release as an effective intervention to reduce unplanned visits and additional tests, therapy, and repeat surgery, while improving patient-reported outcomes and experience.
Level III, therapeutic study.
腕管松解术可阻止腕部特发性正中神经病变（腕管综合征）的进展。间歇性症状往往在手术后缓解，但感觉丧失可能是永久性的。病理生理学（严重神经病变）和心理健康（绝望或担忧的症状）都会导致腕管松解术后恢复出现问题，但它们的相对关联尚不清楚。
问题/目的：腕管松解术后最初恢复出现问题是否与心理困扰有关，而不是与疾病严重程度有关？
我们回顾性研究了 2017 年 11 月至 2020 年 2 月期间在办公室接受腕管松解术的 156 名患者，记录了他们的焦虑症状（广泛性焦虑症 7 项量表[GAD]）和抑郁症状（患者健康问卷）、严重正中神经病变的体征（感觉丧失、鱼际肌萎缩和手掌外展无力）以及恢复不良的情况。如果患者对持续麻木感到不安、出现令人不安的术后疼痛、手部僵硬或出现伤口问题（所有这些都是由治疗外科医生在病历中记录的，同时记录严重正中神经病变的体征），则将最初恢复（前 2 周）归类为恢复不良。24%（38/156）的患者最初恢复出现问题，表现为对持续麻木感到困扰（16%[25/156]）、令人不安的疼痛（8%[12/156]）、手部僵硬（5%[8/156]）或伤口问题（1%[2/156]）；6%（9/156）的患者存在不止一个问题。使用 t 检验、Mann-Whitney 检验和卡方检验评估与最初恢复不良相关的因素，包括年龄、性别、焦虑和抑郁症状、疾病严重程度、特定检查结果和保险，计划如果至少有两个变量与 p<0.10 有相关性，则进行逻辑回归。
唯一与最初恢复不良相关的因素是焦虑症状更严重（最初恢复不良的中位 GAD 评分为 1.5[四分位距 0 至 7.8]，而非恢复不良的中位数为 0[四分位距 0 至 2]；p=0.04），因此我们没有进行逻辑回归。与严重正中神经病变一致的体格检查结果与最初恢复不良无关。
腕管松解术后最初恢复不良与焦虑症状有关，而与正中神经病变的严重程度无关，这一发现强调了在腕管松解术前研究减轻焦虑症状的能力的必要性，这是一种有效的干预措施，可以减少计划外就诊和额外检查、治疗和再次手术，同时改善患者报告的结果和体验。
III 级，治疗研究。
