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Carpal Tunnel Syndrome in Elderly Patients
Young San Ko2, Hee-Jin Yang1 , Sung Bae Park1, Young-Je Son1, Kang Min Kim1, Sang Hyung Lee1, Yeong Seob Chung1
1Department of Neurosurgery, Boramae Medical Center, Seoul, Korea
2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
Correspondence  Hee-Jin Yang ,Tel: 82-2-870-2303, Fax: 82-2-870-3863, Email: nsyangdr@gmail.com
Received: July 12, 2018;  Accepted: August 4, 2018.  Published online: August 4, 2018.
ABSTRACT
Objective:
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Differences in the clinical features and treatment outcomes of CTS between elderly and young patients remain debatable. We analyzed CTS in elderly patients to assess the differences in the characteristics of CTS between elderly and younger patients.
Method:
We retrospectively analyzed patients who were operated for CTS between January 2010 and December 2016. Patients were diagnosed based on clinical features and neurological findings and operated owing to persistent symptoms refractory to conservative management. Nerve conduction study (NCS) and ultrasonography were performed preoperatively. Endoscopic surgery was performed under local anesthesia. Carpal tunnel pressure was measured intraoperatively using the Spiegelberg intracranial pressure monitoring device connected to a parenchymal type catheter.
Results:
We performed 304 operations–48 wrists operated were in patients aged ≥70 years. No significant difference was observed in the sex distribution. The Elderly group showed more severe clinical symptoms (p=0.04), a higher frequency of thenar atrophy (p=0.02), NCS grades indicative of more severe disease (p=0.001), and more prominent median nerve swelling (p=0.04). Both groups showed similar carpal tunnel pressures before and after division of the transverse carpal ligament. Elderly patients showed poorer outcomes than those observed in younger patients (p=0.005).
Conclusion:
Our series demonstrated that elderly patients showed more severe clinical features and findings using supplementary tests. Considering the lack of intergroup differences in carpal tunnel pressure, we conclude that the reaction to compression of the median nerve in elderly patients causes more severe clinical, radiological, and electrodiagnostic features.
Key words: Carpal tunnel syndrome; Elderly patients, Outcome; Carpal tunnel pressure; Treatment outcome
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