Hypothesis:

 Obesity is associated with an increased prevalence of carpal tunnel syndrome and the number of patients presenting for bariatric procedures to treat the comorbidities of morbid obesity is rapidly increasing.  The objective of this study was to investigate the inter-relationships between weight loss, comorbidities, and prevalence of carpal tunnel syndrome in patients who have undergone massive weight loss.

 Methods:

 43 consecutive patients with massive weight loss (>50 lbs) from bariatric procedures or diet and exercise were entered into a prospective database.  Outcome measures included pre- (MAX) and post- (Current) weight loss body mass index, pre and post-weight loss comorbidities, history of carpal tunnel syndrome (CTS) or release (CTR), treatment modalities, current symptoms, and recurrence.  Logistic regression analyses were performed to determine the influence of the independent variables on the presence of carpal tunnel syndrome.

 Results:

 Prior to weight loss, CTS was present in 24 patients (56%, mean Max BMI = 56.3, mean age = 56.5), 13 had CTR (30%) and one patient required a secondary release prior to weight loss. Among the 30 who did not have surgery 15 (50%) had conservative management.   After weight loss, patients who had prior CTR had no recurrence.  Of the 15 patients managed conservatively, 12 (80%) had resolution of symptoms after massive weight loss (p=0.02) (mean Current BMI = 31.8, mean Delta BMI = 21.4).  3 patients (20%) reported residual symptoms of CTS (mean Current BMI = 32.7, Delta BMI =20.3).   Only 1 of the 3 planned to have CTR in the future.  Surgical treatment was associated with Age (p<0.01) (mean Age=56.3 vs. mean Age=45.0 for those with no treatment) and mean current BMI(p=0.05) (mean current BMI=40.8 vs. mean current BMI=32.2 for those with no surgical treatment). Mean Max BMI=60.0 for the group with surgical treatment vs. mean Max BMI=54.0 for those without surgical treatment was suggestive, but failed to achieve significance. Although odds ratios suggested that the resolution of symptoms was related to resolution of hypertension and diabetes, these associations failed to achieve significance. Weight loss method (diet and exercise versus bariatric surgery) did not influence resolution of CTS. 

 Summary:

 More than half of the massive weight loss patients reported symptoms of carpal tunnel syndrome when they were obese. Massive weight loss, irrespective of weight loss method, significantly improved carpal tunnel symptoms in most patients that were initially treated conservatively. Weight loss should be advocated to obese patients with carpal tunnel symptoms and may avoid the need for carpal tunnel release in the future.