Carpal Tunnel Nerve Damage Review Summary
Carpal Tunnel Syndrome: Factors Influencing Permanent Nerve Damage
The incidence of permanent nerve damage (PND) is in part dependent upon the severity of CTS as determined electrodiagnostically at the time of definitive surgical intervention with the Brown Procedure as well as the duration of CTS symptoms. Patients with more severe CTS, as well as patients with a longer duration of CTS, regardless of severity, had a higher incidence of PND. Those patients who underwent non-operative treatment had longer durations of symptoms and higher rates of PND. Efficacy of non-operative treatment has been determined to be less than 2%. Treatment with injected steroids, prior to definitive surgical treatment, resulted in a significantly higher incidence of permanent nerve damage and should, therefore, be abandoned in lieu of performing the Brown Procedure alone. The goal of treating carpal tunnel syndrome (CTS) is not to reduce the symptoms to a tolerable level, but rather to relieve the extrinsic pressure on the median nerve entirely and allow proper blood flow in order to avoid cell necrosis and permanent nerve damage.
We, therefore, recommend abandoning non-operative treatment in favor of the Brown Procedure carpal tunnel release except in those patients presenting with acute or sub-acute CTS with symptoms of less than 6 weeks duration. In those cases, we recommend proceeding with the Brown Procedure unless there has been significant improvement in symptoms in order to minimize the risk of PND.
Patients in this study undergoing such a treatment fared better than other groups.
The authors have conducted a study of 14,722 patients who underwent the Brown Procedure over a 12 year period. The success rate was 97.3%. Interestingly, the failure rate for non-operative treatment is 98%, yet non-operative treatment is still widely practiced and considered “conservative.” We believe the Brown Procedure to be the most conservative treatment, properly timed. Ten year recurrence rate following the Brown Procedure was 3.7%. No pain or minimal pain was reported in 94% of patients. The procedure is performed as outpatient under light general anesthesia, required less than 5 minutes, there are no stitches, and on average, the study showed return to normal activity in 8.7 days.
Michael G. Brown, M.D., Randolph Lopez, M.D., Andrew Lee, M.D., Christopher Hankins, M.D., Joseph Dang, M.D., Brown Hand Center, Houston, Texas
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