Patients with systemic diseases undergoing carpal tunnel release had worse symptoms and functional limitations both prior to and following surgery compared with those without systemic diseases, according to a comparative study of 48 cases published in the Journal of Orthopedics & Orthopedic Surgery. Despite these differences, both groups experienced similar degrees of improvement following surgery.
The findings come from a single-center study of adults treated at Van Yuzuncu Yil University Hospital in Turkey. Researchers compared outcomes in patients with systemic diseases—including rheumatoid arthritis, diabetes mellitus, hypothyroidism, obesity, and hypertension—with outcomes in patients without these conditions.
Study Design and Methods
The study included 48 patients who had undergone carpal tunnel release, divided evenly between those with systemic diseases (n = 24) and those without (n = 24). Groups were matched for age and sex to reduce confounding from known risk factors.
Participants were aged 18 to 64 years and were recruited by telephone, with inclusion limited to those who provided consent.
Symptoms and functional limitations were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), a validated 19-item tool measuring symptom severity and functional capacity on scales ranging from 1 to 5, with higher scores indicating worse outcomes.
Demographic characteristics were similar between groups, including age, sex distribution, height, weight, postoperative duration, and employment status. However, body mass index was higher among patients with systemic diseases (29 vs 26).
Symptom Outcomes
Patients with systemic diseases had higher symptom scores both prior to and following surgery. Preoperative scores averaged 3.2 vs 2.7 in patients without systemic diseases. Postoperative scores averaged 1.6 vs 1.3, respectively.
In both groups, symptom scores improved substantially following surgery. However, the magnitude of improvement was similar, with average reductions of about 1.6 points in patients with systemic diseases and 1.3 points in those without.
Functional Outcomes
Functional limitations followed a similar pattern. Preoperative function scores averaged 3.3 in patients with systemic diseases vs 2.8 in those without. Following surgery, scores improved to 1.8 and 1.4, respectively.
Again, improvement was observed in both groups but was comparable in magnitude, with mean reductions of about 1.6 points vs 1.4 points.
Researchers also found strong positive correlations between preoperative and postoperative scores for both symptoms and function, suggesting that baseline severity was associated with postoperative outcomes.
Interpretation
The findings indicate that systemic diseases associated with carpal tunnel syndrome are linked to worse symptom severity and functional limitations both prior to and following surgery. However, the relative benefit of surgery appears similar regardless of comorbidity status.
As the researchers wrote, “carpal tunnel release surgery exhibited similar therapeutic efficacy in cases with and without systemic diseases,” even though patients with systemic diseases had more severe disease overall.
The authors also noted that systemic conditions may contribute to nerve compression through multiple mechanisms, including inflammatory joint changes in rheumatoid arthritis, neuropathic effects in diabetes, and tissue swelling in hypothyroidism.
Limitations
The study was conducted at a single center and included a small sample size, which may limit generalizability. Recruitment through voluntary participation after telephone contact may have introduced selection bias.
Only five systemic conditions were evaluated because they are commonly associated with carpal tunnel syndrome; other conditions may also influence outcomes. In addition, higher body mass index in the systemic disease group may have acted as a confounding factor, as it is independently associated with carpal tunnel syndrome.
Conclusion
The study demonstrated that systemic diseases are associated with worse symptoms and functional limitations both prior to and following carpal tunnel release, although patients experienced similar improvement regardless of comorbidity status.
The researchers reported no conflicts of interest and no external funding.
