Substantial improvement in short-term pain following carpal tunnel surgery for patients with moderate preoperative electromyography findings is diminished with diabetes and smoking

Stephanie Choo; Tzu Chuan Yen; Rachel Phillips; Rown Parola; Andrea Evenski

doi:10.1016/j.jor.2023.07.025

Substantial improvement in short-term pain following carpal tunnel surgery for patients with moderate preoperative electromyography findings is diminished with diabetes and smoking

J Orthop. 2023 Jul 22:43:57-63. doi: 10.1016/j.jor.2023.07.025. eCollection 2023 Sep.

Authors

Stephanie Choo¹, Tzu Chuan Yen¹, Rachel Phillips¹, Rown Parola¹, Andrea Evenski¹

Affiliation

¹ University Hospital, 1 Hospital Drive, Columbia, MO, 65212, USA.

PMID: 37555204
PMCID: PMC10404856 (available on 2024-09-01)
DOI: 10.1016/j.jor.2023.07.025

Abstract

Purpose: Carpal tunnel syndrome is a common orthopedic diagnosis that often benefits from surgical intervention. There is limited published data analyzing the correlation of smoking and diabetes with the outcomes of open carpal tunnel release, specifically with pain perception and electrophysiology results. The purpose of this study is to determine if smoking and diabetes affect preoperative pain perception in patients with carpal tunnel syndrome when correlated with EMG findings and to determine the differences in pain relief obtained 2 weeks post-operatively in this population.

Methods: Following IRB approval, the authors conducted a retrospective chart review of consecutive patients who underwent open carpal tunnel release from January 1, 2019, to June 30, 2022, by a single surgeon at an academic hospital. Demographic information was collected. Pre- and 2-week postoperative VAS pain scores and the severity of disease assessed by EMG preoperatively were recorded. Subgroup analysis was performed, and patients were further stratified by preoperative EMG result into mild, moderate, and severe cohorts.

Results: Patients who smoked compared to non-smokers had an average improvement in VAS of 2.1 versus 2.8. Patients with reported diabetes compared to non-diabetics had an average improvement in VAS of 2.3 versus VAS of 2.7. Patients who smoked and had diabetes compared to non-smoking, non-diabetic patients reported a change in VAS of 1.92 compared to 2.6. Subgroup analysis of patients with moderate EMG findings demonstrated that patients with diabetes had significantly less improvement in VAS compared to patients without diabetes and smokers had significantly less improvement in VAS compared to non-smokers.

Conclusion: This study showed that among the subgroup of patients with moderate preoperative EMG findings, there was more improvement in pain following carpal tunnel release in non-diabetic patients compared to diabetic patients, and among non-smokers compared to smokers. This study is useful when counseling patients on confounding factors that affect 2-week postoperative recovery.

Keywords: Carpal tunnel syndrome; Diabetes; Electromyography; Smoking.