Article
Carpal tunnel syndrome: Recurrence Assessment SCORE (RASc)
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Published: | February 6, 2020 |
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Objectives/Interrogation: The current literature of carpal tunnel's syndrome lacks appropriate distinction or definition of persistence (eg. due to incomplete release) vs. recurrence following a primary surgical intervention of carpal tunnel release. The aim of our work is to propose a novel methodology to clearly define recurrence based on parameters from a literature review and own clinical data.
Methods: Following ethical board approval, we analysed the medical literature (Medline, Embase) for definitions of recurrence, and reviewed our own retrospective cohort from 2005 to 2015. To objectify clinical decision making, we summarized parameters of symptoms, signs, neurophysiological- and imaging studies in a combined point-based score. A 50 percent reuptake of symptoms following a three-month symptom-free interval was defined as recurrence.
Results and Conclusions: In our cohort of 1094 carpal tunnel syndrome patients, 67 interventions were documented in operative reports as recurrence. Following review of these, we excluded 10 incorrectly classified cases, and patients with comorbidities related to the cervical spine nerve roots.
35 of 57 cases presented without a symptom free interval in the mean 10.1 month follow-up and were classified as persistent carpal tunnel syndrome. Using the above SCORE requirements, 16 cases fit the criteria for recurrence, of which 13 were previously operated on in other hospitals. Intraoperative documentation revealed residual scar tethering in proximity to the median nerve in 15 cases and incomplete release in one.
On mean 7.8 month follow-up of the recurrent cases, 2 cases were entirely free of symptoms, in 10 cases, symptoms had improved and one case worsened, and received additional surgery. 2 cases were lost to follow-up.
While carpal tunnel syndrome recurrence is rare, differences in characteristics of symptoms, signs and electrophysiological studies may explain its causes and should be differentiated from persistent carpal tunnel syndrome following surgery. Our suggested score is quick and easily applicable in daily practice for future use in clinical research focusing on recurrent carpal tunnel syndrome.