CLINICAL AND INSTRUMENTAL PREDICTORS OF THE EFFICIENCY OF CONSERVATIVE AND OPERATIVE TREATMENT OF MEDIAN NERVE NEUROPATHY IN THE CARPAL TUNNEL

Abstract

Introduction. Clinical and instrumental predictors of the efficiency of conservative and surgical treatment of median nerve neuropathy in the carpal tunnel still remain a topical issue. Aim. To identify clinical and instrumental predictors of clinical outcomes and patients’ satisfaction after conservative and surgical treatment of carpal tunnel syndrome. Materials and methods. Analysis of clinical outcomes and patients’ satisfaction in 93 cases with carpal tunnel syndrome: the first group included 49 patients (68 wrists) after conservative and the second group included 44 patients (50 wrists) after surgical treatment. To identify predictors of the efficiency of treatment, analyzed the following clinical-instrumental values: patients’ age, duration of the disease, discriminative sensation, pain intensity according to VAS, values of DASH, BCTQ, CTS scales, clinical stage by Hi-Ob scale, electromyography severity grade according to Bland J.D., nerve conduction study and sonography results. Results. The nerve conduction study and clinical examinations data (discriminative sensation, clinical stage, duration of the disease, BCTQ and DASH values) show reliable effects on clinical outcomes and patients’ satisfaction after conservative treatment. The sensory nerve action potential amplitude and electromyography severity grade have the highest prognostic accuracy (91.4% and 84.5% respectively) for poor (unsatisfactory) result. For surgical treatment, identified results of nerve conduction study, sonography, and patients' age show reliable effects on clinical outcomes and patients’ satisfaction. The values of the highest prognostic accuracy for poor (unsatisfactory) result were nerve deformity index established by sonography (77.8%) and thenar compound muscle action potential amplitude – by nerve conduction study (78.7%). Conclusions. We identified clinical-instrumental predictors of clinical outcomes and patients’ satisfaction after conservative and surgical treatment of carpal tunnel syndrome. Specific results of instrumental examination demonstrated excellent diagnostic quality and the highest prognostic accuracy.