Search for other papers by Christopher R. Brigham in
Current site
Google Scholar
PubMed
Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Abstract
Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.
-
1.
Preston D. Entrapment and other focal neuropathies. Neurol Clin. 1999;17(3):407–424.
-
2.
Uchiyama S, Toriumi H, Nakagawa H, Kamimura M, Ishigaki N, Miyasaka T. Postoperative nerve conduction changes after open and endoscopic carpal tunnel release. Clin Neurophysiol. 2002;113(1):64–70.
-
3.
Olsen KM, Knudson DV. Change in strength and dexterity after open carpal tunnel release. Int J Sports Med. 2001;22(4):301–303.
-
4.
Katz JN, Fossel KK, Simmons BP, Swartz RA, Fossel AH, Koris MJ. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg [Am]. 1995;20(4):549–555.
-
5.
Katz JN, Losina E, Amick BC 3rd, Fossel AH, Bessette L, Keller RB. Predictors of outcomes of carpal tunnel release. Arthritis Rheum. 2001;44(5):1184–1193.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 514 | 514 | 285 |
| Full Text Views | 22 | 22 | 0 |
| PDF Downloads | 0 | 0 | 0 |
