CTS SURGERY FOR 92-YEAR OLD WOMAN

The surgery itself is such a minor procedure that it can be safely performed even in very frail elderly patients under local anaesthetic. The elderly living alone will need help for the first few days after conventional surgery (with most surgeons at least) because the bulky dressing used initially severely restricts what you can do with the hand. Once that is reduced to just a skin dressing over the wound then anyone who was able to look after themselves before surgery should be able to do the same after. The endoscopic (keyhole) operation reduces these problems somewhat but does not solve them entirely.

The prognosis is affected to some extent by age and in our mathematical models for outcome age is an independently significant predictor of the subjective outcome of surgery - with older patients predictably doing less well  - however this is not a very strong effect and some patients in their nineties do get good results from surgery. The nerve conduction study results are a more reliable guide to outcome but having them described simply as 'advanced CTS' is not very helpful - for prognosis you need them classified using a scheme such as the one we use.

I would also caution against making judgements as to what treatment is most appropriate purely on the basis of the lab results - the most important thing is to take note of what symptoms the patient actually wants help with and to combine that with knowledge of what can be expected form surgery to arrive at an individual judgement of whether the operation is likely to solve a particular patient's problem. A patient I saw this week who had a grade 5 CTS nevertheless had advanced wasting of the thumb muscles and great difficulty fastening buttons and such, yet little in the way of pain, or tingling. Surgery is unlikely to benefit this patient greatly and needs to be approached without too much optimism if it is considered. JB