PROGNOSTIC VALUE OF A HAND SYMPTOM DIAGRAM IN SURGERY FOR CARPAL-TUNNEL SYNDROME

Objective, To evaluate symptom patterns on a hand diagram as predictor s of surgical outcome in carpal tunnel syndrome (CTS). Methods, 202 pa tients with CTS enrolled in a prospective, community based cohort stud y in Maine completed a hand symptom diagram before surgery and at 6 mo nth followup. They were asked to mark on the hand diagram the location of 3 symptoms: pain, numbness/tingling (NT), and ''other'' symptoms. The diagram was first divided into 6 regions following a standardized procedure. For the 6 regions, symptom patterns were identified separat ely for each of the 3 symptoms, Outcomes 6 months after surgery were e xpressed as the percentage of change on the Symptom Severity Scale and Function Status Scale of the Carpal Tunnel Syndrome Assessment Questi onnaire, and the satisfaction with the results of the surgery. Results . Several distinct symptom patterns were associated with the 3 princip al outcomes in univariate and multivariate analysis. In linear regress ion models controlling for the baseline severity of symptoms and funct ion, as well as other predictors, the hand symptom pattern variables a ccounted for 30, 14, and 24%, respectively, of the total explained var iance in satisfaction, symptom severity, and functional status. Patien ts receiving Workers' Compensation (37% of the cohort) had more wrist pain and NT of the arm, and less pain involving the arm and upper palm . This group also had worse outcomes and were less satisfied with surg ery. Drawing expansion was associated with a low score on the SF-36 me ntal health subscale. However, psychological impairment was not associ ated with a worse outcome. Conclusion. Symptom patterns identified pre operatively with a hand symptom diagram help to predict the outcome of carpal tunnel release.