Table 2.
Overview of studies evaluating outcome after open carpal tunnel release in individuals’ CTS and with and without diabetes.
| Author, Year | Study Design | N of Individuals (Hands) | Diabetes | Type of Diabetes | Neuropathy | Outcome Measure | Follow-Up Time | Results, Diabetes vs. No Diabetes |
|---|---|---|---|---|---|---|---|---|
| Haupt 1993 [78] | Prospective | 60 (86) | 10/60 (17%) | Not reported | Not reported | Motor function, sensory deficit, trophic changes, neurography and electro-myography | 5.5 years | Marginally less pain relief in individuals with diabetes |
| al-Qattan 1994 [97] | Retrospective | 15 (20) | 15/15 (100%) | Not reported | 15/15 | Grading: excellent/good/poor | 18 months | 5 hands had poor improvement—all of these had normal/mild neurography pre-op |
| Choi 1998 [98] | Retrospective | 154 (294) | 19/154 (12%) | Not reported | 3 (1.9%) | Symptom resolution (poor-excellent) | 12 months | No difference |
| Ozkul 2002 [79] | Prospective | 47 (60) | 22/47 (47%) | T2D | Excluded | PROM: global symptom score, neurography | 12 months | Better PROMs and neurography recovery in individuals without diabetes |
| Mondelli 2004 [99] | Prospective case series | 96 (96) | 24/96 (25%) | T1D: 19 T2D: 5 |
6/24 (25%) | BCTQ | 6 months | No difference |
| Thomsen 2009 [81] | Prospective | 66 (66) | 35/66 (53%) | T1D: 15 T2D: 20 |
14/35 (40%) | Monofilament, 2PD, APB strength, grip strength, key pinch, lateral pinch, pillar pain, postoperative questionnaire (VAS questions) | 52 weeks | Individuals with diabetes had the same beneficial outcome after carpal tunnel release as non-diabetes individuals |
| Thomsen 2010 [59] | Prospective | 66 (66) | 35/66 (53%) | T1D: 15 T2D: 20 |
14/35 (40%) | Electrophysiology testing | 12 months | Electrophysiology improved as much in individuals with as without diabetes |
| Jenkins 2012 [83] | Prospective | 1564 (1564) | 176/1564 (11.3%) | Not reported | Not reported | QuickDASH | 12 months | Poorer functional scores after 12 months in individuals with diabetes, but doubtful whether of clinical significance |
| Isik 2013 [84] | Retrospective case-control | 74 (99) | 36/74 (49%) | T2D | none | PROM questions on symptoms | 12 months | Worse post-op symptoms in individuals with diabetes |
| Zyluk 2013 [85] | Retrospective | 386 (386) | 41/386 (11%) | T1D: 11 T2D: 30 |
None | BCTQ | 6 months | Clinical benefit: no difference. DM individuals had weaker grip strength and poorer perception of touch |
| Ebrahimzadeh 2013 [100] | Retrospective | 74 (74) | 35/74 (47%) | T1D: 14 T2D: 21 |
Not reported | WHOQOL-BREEF; MHQ | 3 months | Worse results in individuals with diabetes, MHQ-scores better in T2D than T1D |
| Cagle 2014 [86] | Prospective | 826 (950) | 90/950 (10%) | Not reported | 20/950 (2%) | BCTQ | 12 weeks | Individuals with diabetes improved but took longer |
| Gulabi 2014 [87] | Prospective | 69 (69) | 27/69 (39%) | T1D: 18 T2D: 9 |
Not reported | BCTQ | 10 years | Individuals with diabetes worse at the 10 years follow-up. No difference at 6 m. |
| Thomsen 2014 [82] | Prospective | 66 (66) | 35/66 (53%) | T1D: 15 T2D: 20 |
14/35 (40%) | BCTQ, monofilament, 2PD, APB strength, grip strength, key pinch, lateral pinch, pillar pain, VAS questions | 5 years | Excellent long-term improvement in individuals with diabetes |
| Yucel 2015 [101] | Retrospective | 83 (101) | 35/83 (42%) | Not reported | Not reported | VAS-questions, BCTQ, monofilament, grip and pinch strength | Not specified | Individuals with diabetes had more symptoms in BCTQ |
| Zimmerman 2016 [89] | Retrospective | 493 (531) | 76/531 (14%) | T1D: 18 T2D: 58 |
18/76 | QuickDASH | 12 months | Same improvement, but more persistent symptoms in individuals with diabetes and polyneuropathy |
| Thomsen 2017 [60] | Prospective | 57 (57) | 27/57 (47%) | T1D: 13 T2D: 14 |
10/27 (37%) | Electrophysiology parameters | 5 years | Long-term electrophysio-logy improvement was seen in both diabetes and non-diabetes individuals |
| Watchmaker 2017 [88] | Prospective | 1031 (1037) | 133/1031 (13%) | Not reported | Not reported | Symptom survey | 6 months | Individuals with diabetes had the same symptom resolution |
| Zhang 2018 [102] | Retrospective | 904 (1144) | Not reported | Not reported | Not reported | Secondary surgery | 60 months | DM associated with greater risk of secondary surgery |
| Zimmerman 2019 [90] | Retrospective | 9049 (10,770) | 1508/9049 (17%) | T1D: 335 T2D: 1150 |
Not reported | QuickDASH | 12 months | Individuals with diabetes benefitted from surgery, but not to same extent as patients without diabetes |
APB: adductor pollicis brevis muscle, BCTQ: Boston Carpal Tunnel Questionnaire, DM: diabetes mellitus, PROM: Patient-reported outcome measure, QuickDASH: short version of disabilities of arm, shoulder and hand, T1D: type 1 diabetes, T2D: type 2 diabetes, 2PD: two-point discrimination, VAS: visual analogue scale.