Article
Preoperative Two Point Discrimination Predicts Response to Carpal Tunnel Release
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Published: | February 6, 2020 |
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Objectives/Interrogation: Two-point discrimination (2PD) correlates to digital innervation and is used as a measure of carpal tunnel severity. However, there is no study to date that has assessed whether preoperative 2PD scores predict symptom severity or response to surgery. The primary aim of this study was to determine the predictive value of preoperative 2PD scores on postoperative symptom severity following carpal tunnel release.
Methods: All patients who underwent carpal tunnel release by a single fellowship-trained surgeon between 2014 and 2018 were retrospectively reviewed. Diagnosis was based on CTS-6 criteria, and surgery was offered based on failure of conservative management. Evaluation of static 2PD was performed and absent preoperative 2PD was defined as a measurement >10 mm. Pre- and postoperative QuickDASH and Levine-Katz scores were recorded. Pearson correlation coefficients assessed the relationship between preoperative 2PD scores, postoperative 2PD scores, and patient-rated outcome scores.
Results and Conclusions: Eighty-four hands were analyzed in this study. Mean post-operative follow-up was 1.8 years. Mean pre- and postoperative 2PD was 7.6mm (n=67) and 6.5mm (n=52), respectively. A higher initial 2PD was associated with an increased likelihood of improvement in 2PD postoperatively (r2 = 0.088, p=0.006) unless 2PD was absent (Figure 1 [Fig. 1]). Additionally, there was a positive correlation between pre- and postoperative 2PD (r2 = 0.61, p<0.05) (Figure 2 [Fig. 2]). Patients with absent preoperative 2PD were the least likely to demonstrate postoperative improvement in 2PD from baseline with only 40.0% (6/20) of patients demonstrating improvement in contrast to 68.8% (44/64) patients otherwise (p = 0.03).