Elsevier

The Journal of Hand Surgery

Volume 32, Issue 8, October 2007, Pages 1154-1158
The Journal of Hand Surgery

Nerve
Comparing the Outcome of a Carpal Tunnel Decompression at 2 Weeks and 6 Months

https://doi.org/10.1016/j.jhsa.2007.05.032Get rights and content

Purpose

The purpose of the study was to evaluate if 2-week Levine score can provide an adequately responsive outcome measure in carpal tunnel decompression by comparing it with 6-month score.

Methods

The treatment outcome of 300 patients with carpal tunnel decompression was determined by using Levine score at 2 weeks and 6 months after surgery. The mean age of patients was 56 years, 71% (214) were women, and 55% (167) of operations were performed on the right hand. All patients were scored using the Levine questionnaire preoperatively and at 2 weeks and 6 months from date of surgery. The correlation between the scores was evaluated.

Results

Although statistical significance was found between the preoperative score and the scores at both 2 weeks and 6 months, no statistical difference was found between the scores at 2 weeks and 6 months after surgery. Multiple regression analysis with the 2 week-6 month score difference as the dependent variable shows a predictable outcome at 2 weeks.

Conclusions

We conclude that the Levine score at 2 weeks is a reliable, responsive, and practical instrument for outcome measure in carpal tunnel surgery. It coincides with suture removal and provides a convenient and predictive assessment of the medium-term results in a high percentage of treated patients. We conclude that the 2 time points, 2 weeks and 6 months, are equivalent in outcome because a less than 10-point difference is not clinically meaningful.

Type of study/level of evidence

Prognostic II.

Section snippets

Materials and Methods

We used the self-administered questionnaire designed by Katz and Levine, which is also known as the Boston questionnaire. This is in 2 parts. The first part consists of 11 questions concerning the severity in symptoms, with each answer scored from 1 to 5 in the ascending order of severity of symptoms, making a total score of 55, with 11 being the best and 55 the worst score. This is the symptom severity score (SSS). The other section has 8 questions of activities of daily living, scored from 1

Results

Scores improved significantly between the preoperative period and 2 weeks postoperatively as well as between the preoperative period and 6 months postoperatively (Table 1, Table 3).

Overall, 291 (97%) patients had improvement of symptoms and 294 (98%) improved functionally. Whereas no patient had the lowest combined total score (19) before operation, 94 patients had this score postoperatively (Table 2). After 6 months, 9 (3%) patients had deterioration of SSS by 10 points or more; only 6 (2%)

Discussion

The questionnaire used here measures symptoms and functional status but in different spectrums of the disease. We have considerable experience with the Boston questionnaire in the assessment of carpal tunnel syndrome and find it easy to apply. Other questionnaires, however, are available, such as the Michigan Hand questionnaire and the DASH questionnaire1, 7 or the more recently developed Stothard and Kamath questionnaire,5 all of which have shown to be equally responsive to the Boston

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