Does Hypothyroidism Affect Post-Operative Outcome of Patients Undergoing Carpal Tunnel Release?

Prevalence of Hypothyroidism Among Carpal Tunnel Syndrome Patients at a Hospital in Saudi Arabia

Introduction

Patients with carpal tunnel syndrome have a high prevalence of hypothyroidism, therefore, it is recommended to assess thyroid function routinely in patients with carpal tunnel syndrome. This study aims to determine the prevalence of hypothyroidism among carpal tunnel patients and to relate carpal tunnel in hypothyroidism to other socio-demographic factors.

Methods

This was a retrospective study carried out in King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. A total of 422 samples were collected conveniently from the files of patients who underwent carpal tunnel release surgery. The Statistical Package for the Social Sciences (SPSS) version 23 was used for data processing. The chi-square test was used to test the association between the categorical variables. A p-value of less than .05 was considered to be significant.

Results

Most of the respondents were females and most of them within the age group of 46 to 60 years. Thirteen point eight percent (13.8%) of the respondents are suffering from hypothyroidism and 5% from the sub-clinical form of the disease. More than two-thirds of those with hypothyroidism were asymptomatic. The duration of the disease was one to five years, and bilateral nerve concerns were mostly present in patients with carpal tunnel syndrome. The presence of thyroid abnormality doesn’t affect the duration of carpal tunnel syndrome but body mass index (BMI) is significantly associated with hypothyroidism (p-value = .001).

Conclusion

Clinical symptoms of hypothyroidism are mostly absent in patients with carpal tunnel syndrome. Most patients with carpal tunnel syndrome have the disease for one to five years and this is not significantly associated with abnormal thyroid. Most patients have bilateral wrist involvement with no apparent symptoms and signs.

Hypercholesterolemia Is Associated with the Subjective Evaluation of Postoperative Outcomes in Patients with Idiopathic Carpal Tunnel Syndrome Who Undergo Surgery: A Multivariate Analysis

BACKGROUND

Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist; its symptoms include neuropathic pain and sensory and motor disturbance distributed by the median nerve. Carpal tunnel syndrome and hypercholesterolemia have similar backgrounds, but the effect of these similarities on postoperative outcomes has not been reported. Using multivariate analysis, the authors analyzed the relationship between prognostic factors, including the presence of hypercholesterolemia, and subjective postoperative outcomes of patients with idiopathic carpal tunnel syndrome.

METHODS

Of 168 hands with carpal tunnel syndrome that were treated surgically, 141 that were followed up and assessed 1 year postoperatively or thereafter were included. The mean postoperative follow-up period was 40.8 months. Surgery was performed through a small palmar skin incision under local anesthesia. The outcomes were postoperative symptoms, including pain and numbness, and overall Kelly assessment.

RESULTS

Preoperative numbness and pain resolved and alleviated in 94 of 141 hands and was diminished in 59 of 64 hands. Univariate analysis showed that postoperative numbness and Kelly assessment were significantly associated with hypercholesterolemia. Multivariate analysis showed that postoperative numbness was significantly associated with smoking and hypercholesterolemia, and Kelly assessment was significantly associated with smoking (adjusted OR, 3.3; 95 percent CI, 1.1 to 10; p = 0.04) and hypercholesterolemia (adjusted OR, 2.9; 95 percent CI, 1.4 to 6.3; p = 0.01).

CONCLUSION

Hypercholesterolemia, usually a systemic condition in sites other than the hand, is associated with the subjective evaluation of postoperative symptoms in patients with idiopathic carpal tunnel syndrome.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.