Is There an Urge to Operate the Patients with Severe Carpal Tunnel Syndrome? A Year of Neurophysiological Follow Up of Severe CTS

Abstract OBJECTIVES: Several approaches have been proposed for the treatment of carpal tunnel syndrome (CTS) based on its severity. The aim of this study is to determine the optimal management for severe CTS.  METHODS: This study was conducted in a cross-sectional fashion during a 22-month period from August 2017 to June 2019 in a referral rehabilitation clinic in southern Iran. A total of 117 hands diagnosed with severe CTS were included in 78 patients according to Electro-diagnostic study (EDX) results (considering Sensory Proximal Latency (SPL)>3.6 msec, Sensory Distal Latency (SDL)>5.3 msec, Sensory Nerve Conduction Velocity (SNCV) <30 m/sec, Distal Motor Latency (DML)>6.5 msec as being severe) who refused to undergo surgery.  Boston questionnaire was filled out and conventional EDX was carried out at the first and at the 1-year follow-up visits. RESULTS:  In patients with detectable sensory nerve action potential (SNAP), motor amplitude (P<0.002) and latency (p<0.01), SPL (p<0.003) and SNCV (p<0.006), and Boston parameters improved significantly in the 1-year follow-up visit compared to results at first visit. However, improvement in patients with absent or low amplitude SNAP at first visit was only observed in proximal sensory latency (p<0.005) and amplitude (p<0.003).  CONCLUSIONS: There is a considerable chance for non-surgical improvement of patients with severe CTS in terms of symptom relief, hand function and EDX parameters in those with detectable SNAP at first visit; however, patients with undetectable SNAP have little, if any, chance for improvement with conservative measures.