Too Old for Carpal Tunnel Surgery? No Such Thing
Oct. 27, 2000 -- Eighty years old, with no feeling in her hand, the patient was just one of many elderly men and women that Kari Todnem, MD, had treated for carpal tunnel syndrome -- an inflammation causing pain, numbness, or tingling in the wrist, hand, and fingers.
"She couldn't do any of her favorite activities, like crocheting or knitting," recalls Todnem, a physician in the department of clinical neurophysiology at the University Hospital of Trondheim in Norway.
Todnem explains that in this patient, the median nerve, which runs down a "tunnel" of muscles in the arm and sends sensory signals to the fingers and hands, was entirely trapped by the inflammation of surrounding tissues. The result was a complete lack of feeling and wasting of the muscle at the base of the thumb, which helps move the hands and fingers.
Conventional therapies didn't help. But when Todnem recommended surgery to correct the condition, she confronted another obstacle. "The surgeon declined to operate because he said she was too old," Todnem tells WebMD.
The experience stuck with Todnem, and this month she and her colleagues have published a study in a recent issue of the journal Muscle and Nerve, showing what she had suspected: many elderly patients can benefit from surgery to correct carpal tunnel syndrome.
In the study, three groups of patients were compared: One group of patients aged 70 to 89 received surgery; a second group aged 30 to 69 also received surgery; and a third group of patients aged 25 to 83 who did not receive surgery.
The elderly patients had significant improvement after surgery, comparable to the younger patients who had surgery. Both young and old patients who did not receive surgery also improved, but not as much as the group that went under the knife, according to the study.
The conclusion: "Elderly people who are having a hard time should get an operation," Todnem tells WebMD.
"Patients with pain and numbness in the hands, problems with hand crafts, buttoning clothes, or handling small objects should have surgery," she says. "This is a small operation performed with local anesthesia. The prognosis is excellent, and numbness will disappear quickly and [sensations] will normalize."
Todnem says she realizes that many patients, young and old, would prefer not to have surgery, but says that physicians can determine relatively easily which patients would benefit from surgery and which can wait.
Proper selection of patients who are candidates for surgery is critical, Todnem says. If there is permanent loss of sensation, that is a sign that the median nerve has become "entrapped," causing the muscles to waste. In that case, surgery is recommended, she says.
An exam using an electrical device that measures how fast a signal travels down the median nerve, can also help determine which patients would be best suited for surgery, she says.