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Exploring the Role of Biopsy-Proven Diabetic Neuropathy in Outcomes of Carpal Tunnel Release in Diabetic and Non-Diabetic Populations
Joel Quinones, OMS IV1; Monsivais Jose, MD2; Neda Shaghaghi, MS31; Ayeza Jamil, MS33
1Burrell College of Osteopathic Medicine, Las Cruces, NM; 2Hand and Microsurgery Center of El Paso, El Paso, TX; 3Burrell College of Ostepathic Medicine, Las Cruces, NM

Introduction: The objective of this study was to explore the role of biopsy- proven diabetic neuropathy in outcomes of carpal tunnel release in diabetics and non-diabetics using patient reported outcomes.
Materials and Methods: This was a prospectively planned, retrospective study. Diabetic and non-diabetic patients who underwent carpal tunnel surgery and skin biopsies from 2015 to 2021 were selected from a hand surgeonís patient database. 65 diabetic patients and 105 non-diabetic patients were randomly selected. Patient outcomes were evaluated using preoperative and postoperative pain scale assessments including Disabilities of Arm Shoulder and Hand (DASH), Brief pain Index (BPI), Wong-Baker, Numeric Pain Scales, and Boston Questionnaire Postoperative evaluations were taken 6 months to a year post-surgery.
Results: The results of the study show that non-diabetic patients had a greater recovery rate than diabetic patients when comparing all five assessments. The numerical pain scale for non-diabetics improved by 64%. Wong-Baker scores improved by 58%, DASH score improved by 19.2%, BPI improved 42%, and the Boston Questionnaire improved by 47%. In comparison, the diabetic population numerical pain scale had a 51% improvement, Wong-Baker assessment improved by 28%, DASH improved by 12%, BPI improved by 27%, and the Boston Pain scale improved 7%. Of the 40 biopsies taken from diabetic patients, 20 were positive for small fiber neuropathy and 20 were negative. When comparing diabetics with biopsy-proven neuropathy to diabetics without neuropathy, the outcomes are increasingly better for diabetics without neuropathy. The difference in Wong-Baker using initial and subsequent measures, for both biopsy-proven neuropathy and without neuropathy, are about the same: 1.23 and 0.89. The greatest improvement in non-diabetics without neuropathy was seen on the numeric pain scale, DASH, BPI, and Boston Questionnaire with differences between initial and subsequent assessments at 3.46, 18.97, 19.66, and 0.56 respectively. Diabetics with biopsy-proven neuropathy have an improvement in outcomes as well; however, not as much as non-diabetics. The numeric pain scale, DASH, BPI, and Boston Pain Scale differences between initial and subsequent assessments were the following: 2.87, 9.89, 12.94, and 0.08.
Conclusion: The diagnosis of biopsy-proven small fiber neuropathy limits the recovery rate of diabetic patients. The recovery rate of non-diabetics is greater than diabetics after undergoing carpal tunnel surgery


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