Article
How trapeziometacarpal arthritis and scaphotrapeziotrapezoidal arthritis affect the postoperative recovery of carpal tunnel syndrome
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Authors
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Kaori Sugiura
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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Takao Omura
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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Michihito Miyagi
- Shizuoka Cancer Center, Nagaizumi, Japan
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Tomokazu Sawada
- Shizuoka City, Shizuoka Hospital, Shizuoka, Japan
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Ryo Okabayashi
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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Takashi Ogawa
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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Hiroaki Ogihara
- Hamamatsu Red Cross Hospital, Hamamatsu, Japan
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Yukihiro Matsuyama
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Carpal Tunnel Syndrome(CTS) is the most common peripheral compression neuropathy primarily affecting postmenopausal women. Trapeziometacarpal(TMC) and scaphotrapeziotrapezoidal(STT) arthritis is also commonly encountered in postmenopausal women. The purpose of this study is to examine the prevalence of TMC and STT arthritis in patients with CTS, and to analyze how the arthritis affect the postoperative recovery of CTS.
Methods: 123 hands who underwent carpal tunnel release between 2002 and 2017 were studied. The patients consisted of 34 men and 89 women, with a mean age of 65.8(33~92) years old. The mean follow up period was 11.7(3~24) months. The severity of the TMC arthritis was determined using Eaton's classification. The patients were divided into four groups; joints with TMC stage1 or less without STT arthritis were classified as group N(63hands), joints with TMC stage2 and 3 were classified as group TMC(39hands), joints with TMC stage4 were classified as group TMCSTT(12hands) and joints with just STT arthritis were classified as group STT (9hands). For the evaluation of CTS, pre and postoperative manual muscle testing (MMT) of abductor pollicis brevis (APB) and distal motor latency (DML) detected on the APB muscle was examined. These results were cross compared between group N and the rest of the groups.
Results and Conclusions: The electrophysiological study showed that the mean preoperative DML had no statistical difference among the groups. The mean postoperative DML was 4.53ms for group N, 4.97ms for group TMC, 4.51ms for group TMCSTT and 4.83ms for group STT, showing statistical significance between group TMC and group N. However, when we performed one-way covariance analysis to exclude the influence of age, age adjusted mean DML was 4.66ms for N group and 4.85ms for group TMC, which showed no statistical difference.
The muscle strength recovery of APB revealed that, the number of the cases with MMT3 or less showed no statistical difference preoperatively. However, postoperative evaluation showed that while only 14 hands (22%) in group N and 1 hand (11%) in group STT showed MMT 3 or less, 16 hands (41%) in group TMC and 5 hands (42%) in group TMCSTT failed to achieve over MMT3, showing statistical significance between group TMC, TMCSTT and group N.
We conclude that the prevalence of TMC and STT arthritis was 41.5% and 7.3% in patients with CTS. The presence of TMC arthritis in patients with CTS negatively affects the postoperative recovery of the APB muscle after carpal tunnel release.
