Background: Following the introduction of endoscopic techniques for the treatment of carpal tunnel syndrome (CTS) in the late 1980’s, significant controversy ensued regarding the efficacy, safety, and success of these procedures. The effect of open versus endoscopic procedure on the symptom resolution has been reported in many studies. A variety of outcome measures have been used to compare the results among different patient populations. The outcome in the elderly patient population has somewhat poorly defined. Symptom resolution following CTS surgery in the elderly, in particular, may be compromised by a potentially detrimental effect of advancing age on nerve regeneration. In this study, we used two standardized outcome instruments (SF-36 and DASH) for the evaluation of patients over 60 years of age.

Patients and Methods: A total of 120 patients were retrospectively evaluated using mental and physical short form-36 (SF-36), and disabilities of the arm, shoulder and hand (DASH) outcome measure. Eighteen (15%) patients had the endoscopic carpal tunnel release (ECTR), and 102 (85%) had open carpal tunnel release (OCTR). The mean follow-up for OCTR and ECTR groups were 1.98 and 2.32 years, respectively. Two-sided unequal-variances t-tests were used to compare mental and physical SF-36 and DASH scores between the OCTR and ECTR groups.

Results:

SF36: Comparisons of all the sub-groups of SF-36 revealed that mental scores were significantly higher in the ECTR group than in the OCTR group (p=0.001), but no differences were found when physical scores were compared between the groups (p=0.64). This is confirmed by the results from analysis of covariance models after adjusting for follow-up, age, and gender (Table 1).

DASH: Mean DASH scores in ECTR and OCTR groups were 24.07 and 21.54, respectively. After adjusting for follow-up, age and gender, DASH scores were not significantly different between the groups (Table 1).

Outcome Measure	OCTR (n:102)	ECTR (n:18)
SF-36 Physical Functioning	59.17	57.85
SF-36 Role-Physical	23.52	25.00
SF-36 Pain Index	54.68	56.59
SF-36 General Health Perception	61.03	65.31
SF-36 Vitality	57.76	60.94
SF-36 Social Functioning	74.26	82.35
SF-36 Role-Emotional	51.42	79.63
SF-36 Mental Health Index	75.33	78.92
Standardized Mental Component	50.45	58.43
Standardized Physical Component	36.7	35.9
DASH Score	21.54	24.07

Table1

Discussion

The clinical outcomes of carpal tunnel surgery in the elderly were equivalent for both endoscopic and open techniques when evaluated at about 2 years after surgery when using the SF-36 and DASH.  Interestingly, comparing all the sub-groups of SF-36 revealed that mental scores were significantly higher in the ECTR group than in the OCTR group (p=0.001),