Original Article
The Journal of Hand Surgery (Asian-Pacific Volume) 2017;22(3):303-308 • DOI: 10.1142/S0218810417500344
The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome Qian Ying TANG*, Wei Hong LAI*, Shian Chao TAY† *Yong Loo Lin School of Medicine, National University of Singapore, Department of Hand Surgery, Singapore General Hospital, Singapore
J Hand Surg Asian-Pac Vol 2017.22:303-308. Downloaded from www.worldscientific.com by UNIVERSITY OF AUCKLAND on 09/15/17. For personal use only.
†
Background: There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. Methods: Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). Results: In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. Conclusions: Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome. Keywords: Bilateral carpal tunnel syndrome, Severe, Hand dominance, Patient reported outcomes
INTRODUCTION Literature about the relationship between hand dominance and carpal tunnel syndrome is scant. Whilst there Received: Apr. 14, 2016; Revised: Jul. 28, 2016; Accepted: Jul. 29, 2016 Correspondence to: Shian Chao TAY Department of Hand Surgery, Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore Tel: +65-6222-3322, Fax: +65-6224-9221 E-mail: [email protected]
have been published studies which examine the effect of hand dominance on the pathophysiology of carpal tunnel syndrome,1) the effect of hand dominance on recovery of carpal tunnel syndrome remains unexplored. A 1981 paper by Reinstein2) reported that carpal tunnel syndrome was found to occur significantly more frequently in the dominant hand and concluded that the increased daily activity of the dominant hand was a contributing factor in the development of carpal tunnel syndrome. Similarly, Wee and Abernathy3) reviewed electrodiagnostic studies consistent with carpal tunnel syndrome
304
J Hand Surg Asian-Pac Vol 2017.22:303-308. Downloaded from www.worldscientific.com by UNIVERSITY OF AUCKLAND on 09/15/17. For personal use only.
Qian Ying TANG, et al. Hand Dominance and Patient-Reported Outcomes in Bilateral Carpal Tunnel Syndrome
in 68 patients and reported that median compound sensory nerve action potential (CSNAP) abnormalities were relatively worse in the dominant hand among righthanders but not in left-handers. They postulated that left-handers might have a greater tendency to use either hand when performing certain manual tasks compared to right-handers, hence producing equal amount of repetitive stress on the median nerve in both wrists. By searching existing literature using Medline and PubMed (search terms used: carpal tunnel syndrome, hand dominance, handedness, recovery, surgery, carpal tunnel release, resolution of symptoms), we did not discover any studies pertaining to the role of hand dominance on the resolution of symptoms following carpal tunnel release. This study hence aims to address this gap in existing literature by examining the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome.
METHODS Subjects With Institutional Review Board approval, a retrospective analysis of 174 hands in 87 consecutive patients (11 males and 76 females; mean age 54.5 years ± 12.0 years; range 30–90 years) who had bilateral severe or moderate carpal tunnel syndrome and undergone bilateral carpal tunnel release (90 open and 84 endoscopic) between January 2002 and December 2012 was performed. All patients included in the study were diagnosed with carpal tunnel syndrome clinically, and had their pre-operative severity assessed by a nerve conduction study conducted by an independent neurologist, and severity was graded according to previously published neurophysiological classification system.4) Patients were included in the study if clinical presentation and nerve
conduction studies showed equal severity of carpal tunnel syndrome bilaterally. All patients reported bilateral numbness of equal severity. None of the carpal tunnel release operations were performed at the same seating. 22 patients who received endoscopic release in one hand and open release in the other hand were excluded from this study. 11 and 1 patient had concurrent trigger finger release and wrist ganglion removal performed at the same sitting as the carpal tunnel release respectively. There were no patients with inflammatory joint disease. Based on the results of nerve conduction studies and clinical presentation, there were 61 patients with severe carpal tunnel syndrome and 26 with moderate carpal tunnel syndrome (Table 2). Follow-Up Patients were followed up continuously until complete resolution of their symptoms was recorded or until their final follotw-up consultation. The minimum followup duration was 3 months. The mean follow-up duration was 11.36 ± 6.3 months (range 3.1 to 32.4 months). Statistical Analysis Statistical analysis of the data collected was performed using IBM SPSS Statistics version 20. A p value of
The Journal of Hand Surgery (Asian-Pacific Volume) 2017;22(3):303-308 • DOI: 10.1142/S0218810417500344
The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome Qian Ying TANG*, Wei Hong LAI*, Shian Chao TAY† *Yong Loo Lin School of Medicine, National University of Singapore, Department of Hand Surgery, Singapore General Hospital, Singapore
J Hand Surg Asian-Pac Vol 2017.22:303-308. Downloaded from www.worldscientific.com by UNIVERSITY OF AUCKLAND on 09/15/17. For personal use only.
†
Background: There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. Methods: Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). Results: In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. Conclusions: Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome. Keywords: Bilateral carpal tunnel syndrome, Severe, Hand dominance, Patient reported outcomes
INTRODUCTION Literature about the relationship between hand dominance and carpal tunnel syndrome is scant. Whilst there Received: Apr. 14, 2016; Revised: Jul. 28, 2016; Accepted: Jul. 29, 2016 Correspondence to: Shian Chao TAY Department of Hand Surgery, Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore Tel: +65-6222-3322, Fax: +65-6224-9221 E-mail: [email protected]
have been published studies which examine the effect of hand dominance on the pathophysiology of carpal tunnel syndrome,1) the effect of hand dominance on recovery of carpal tunnel syndrome remains unexplored. A 1981 paper by Reinstein2) reported that carpal tunnel syndrome was found to occur significantly more frequently in the dominant hand and concluded that the increased daily activity of the dominant hand was a contributing factor in the development of carpal tunnel syndrome. Similarly, Wee and Abernathy3) reviewed electrodiagnostic studies consistent with carpal tunnel syndrome
304
J Hand Surg Asian-Pac Vol 2017.22:303-308. Downloaded from www.worldscientific.com by UNIVERSITY OF AUCKLAND on 09/15/17. For personal use only.
Qian Ying TANG, et al. Hand Dominance and Patient-Reported Outcomes in Bilateral Carpal Tunnel Syndrome
in 68 patients and reported that median compound sensory nerve action potential (CSNAP) abnormalities were relatively worse in the dominant hand among righthanders but not in left-handers. They postulated that left-handers might have a greater tendency to use either hand when performing certain manual tasks compared to right-handers, hence producing equal amount of repetitive stress on the median nerve in both wrists. By searching existing literature using Medline and PubMed (search terms used: carpal tunnel syndrome, hand dominance, handedness, recovery, surgery, carpal tunnel release, resolution of symptoms), we did not discover any studies pertaining to the role of hand dominance on the resolution of symptoms following carpal tunnel release. This study hence aims to address this gap in existing literature by examining the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome.
METHODS Subjects With Institutional Review Board approval, a retrospective analysis of 174 hands in 87 consecutive patients (11 males and 76 females; mean age 54.5 years ± 12.0 years; range 30–90 years) who had bilateral severe or moderate carpal tunnel syndrome and undergone bilateral carpal tunnel release (90 open and 84 endoscopic) between January 2002 and December 2012 was performed. All patients included in the study were diagnosed with carpal tunnel syndrome clinically, and had their pre-operative severity assessed by a nerve conduction study conducted by an independent neurologist, and severity was graded according to previously published neurophysiological classification system.4) Patients were included in the study if clinical presentation and nerve
conduction studies showed equal severity of carpal tunnel syndrome bilaterally. All patients reported bilateral numbness of equal severity. None of the carpal tunnel release operations were performed at the same seating. 22 patients who received endoscopic release in one hand and open release in the other hand were excluded from this study. 11 and 1 patient had concurrent trigger finger release and wrist ganglion removal performed at the same sitting as the carpal tunnel release respectively. There were no patients with inflammatory joint disease. Based on the results of nerve conduction studies and clinical presentation, there were 61 patients with severe carpal tunnel syndrome and 26 with moderate carpal tunnel syndrome (Table 2). Follow-Up Patients were followed up continuously until complete resolution of their symptoms was recorded or until their final follotw-up consultation. The minimum followup duration was 3 months. The mean follow-up duration was 11.36 ± 6.3 months (range 3.1 to 32.4 months). Statistical Analysis Statistical analysis of the data collected was performed using IBM SPSS Statistics version 20. A p value of
