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Carpal and Cubital Tunnel Syndrome: Who Gets Surgery?

  • Symposium: Gender-specific Issues in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Despite the prevalence of carpal and cubital tunnel syndrome, and relief of symptoms following timely surgical release, it is unclear how nonclinical patient characteristics affect disease management.

Questions/purposes

We examined the effects of a variety of factors, such as age, gender, and socioeconomic status on the management of both carpal and cubital tunnel syndromes.

Patients and Methods

We retrospectively reviewed the records of all 273 patients seen by two hand surgeons with a diagnosis of either carpal or cubital tunnel syndrome between January 2005 and January 2007. Demographic, clinical (diagnosis, treatment), and socioeconomic (insurance type, median income) information was collected. Census data (2000) were used to collect information on median household income. The average age was 52 years (range, 19–87 years), and 65% of the patients were women (n = 178). Eighteen patients had Workers Compensation. Of the 273 patients, 86 (32%) had two or more diagnoses.

Results

Among patients with carpal tunnel syndrome, there was a higher proportion of female patients compared to male patients (68% versus 32%); male patients with multiple neuropathies had higher rates of surgery than their female counterparts (63% versus 41%). Only increasing age was associated with increasing likelihood of surgery. Among multiple-diagnosis patients, those with Workers Compensation (n = 6) had higher wait times for surgery than their counterparts (n = 46) (126 days versus 26 days).

Conclusion

Patient age was the most important predictor of surgical release, and among those with multiple neuropathies, male patients were more likely to have surgery than female patients. Patients with Workers Compensation may experience long wait times to surgery.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Boyd KU, Gan BS, Ross DC, Richards RS, Roth JH, MacDermid JC. Outcomes in carpal tunnel syndrome: symptom severity, conservative management and progression to surgery. Clin Invest Med. 2005;28:254–260.

    PubMed  Google Scholar 

  2. Capasso M, Manzoli C, Uncini A. Management of extreme carpal tunnel syndrome: evidence from a long-term follow-up study. Muscle Nerve. 2009;40:86–93.

    Article  PubMed  Google Scholar 

  3. Daniell WE, Fulton-Kehoe D, Franklin GM. Work-related carpal tunnel syndrome in Washington State workers’ compensation: Utilization of surgery and the duration of lost work. Am J Ind Med. 2009 Oct 28. [Epub ahead of print]

  4. Dias JJ, Burke FD, Wildin CJ, Heras-Palou C, Bradley MJ. Carpal tunnel syndrome and work. J Hand Surg Br. 2004;29:329–333.

    Article  CAS  PubMed  Google Scholar 

  5. Ettema AM, Amadio PC, Cha SS, Harrington JR, Harris AM, Offord KP. Surgery versus conservative therapy in carpal tunnel syndrome in people aged 70 years and older. Plast Reconstr Surg. 2006;118:947–958.

    Article  CAS  PubMed  Google Scholar 

  6. Foley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State. Am J Ind Med. 2007;50:155–172.

    Article  PubMed  Google Scholar 

  7. Gelfman R, Melton LJ 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology. 2009;72:33–41.

    Article  CAS  PubMed  Google Scholar 

  8. Gong HS, Baek GH, Oh JH, Lee YH, Jeon SH, Chung MS. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am. 2009;91:2130–2136.

    Article  PubMed  Google Scholar 

  9. Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syntrome. J Bone Joint Surg Am. 2008;90:2587–2593.

    Google Scholar 

  10. Hobby JL, Venkatesh R, Motkur P. The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome. J Hand Surg Br. 2005;30:599–604.

    Article  CAS  PubMed  Google Scholar 

  11. Ibrahim T, Majid I, Clarke M, Kershaw CJ. Outcome of carpal tunnel decompression: the influence of age, gender, and occupation. Int Orthop. 2008 October16 [Epub ahead of print].

  12. Lam N, Thurston A. Association of obesity, gender, age and occupation with carpal tunnel syndrome. Aust N Z J Surg. 1998;68:190–193.

    Article  CAS  PubMed  Google Scholar 

  13. Löfvendahl S, Eckerlund I, Hansagi H, Malmqvist B, Resch S, Hanning M. Waiting for orthopedic surgery: factors associated with waiting times and patients’ opinion. Int J Qual Health Care. 2005;17:133–140.

    Article  PubMed  Google Scholar 

  14. Lorgelly PK, Dias JJ, Bradley MJ, Burke FD. Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial. Ann R Coll Surg Engl. 2005;87:36–40.

    Article  PubMed  Google Scholar 

  15. Moghtaderi A, Izadi S, Sharafadinzadeh N. An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome. Acta Neurol Scand. 2005;112:375–379.

    Article  CAS  PubMed  Google Scholar 

  16. Pomerance J, Zurakowski D, Fine I. The cost-effectiveness of nonsurgical versus surgical treatment for carpal tunnel syndrome. J Hand Surg Am. 2009;34:1193–1200.

    Article  PubMed  Google Scholar 

  17. Richardson JK, Green DF, Jamieson SC, Valentin FC. Gender, body mass, and age as risk factors for ulnar mononeuropathy at the elbow. Muscle Nerve. 2001;24:551–554.

    Article  CAS  PubMed  Google Scholar 

  18. Townshend DN, Taylor PK, Gwynne-Jones DP. The outcome of carpal tunnel decompression in elderly patients. J Hand Surg Am. 2005;30:500–505.

    Article  PubMed  Google Scholar 

  19. U.S. Census FactFinder Web site. “2000 Summary File 3.” http://factfinder.census.gov/servlet/DTGeoSearchByListServlet?ds_name=DEC_2000_SF3_U&_lang=en&_ts=276019791361. Accessed September 2, 2008.

  20. Wasiak R, Pransky G. The impact of procedure type, jurisdiction and other factors in workers’ compensation on work-disability outcomes following carpal tunnel surgery. Work. 2007;28:103–110.

    PubMed  Google Scholar 

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Acknowledgments

We thank Dr. David Zurakowski (Childrens Hospital, Boston, MA) for his assistance with the statistical portion of this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Charles S. Day MD, MBA, Eric C. Makhni BS, Erika Mejia BA, Daniel E. Lage & Tamara D. Rozental MD

  2. Harvard Medical School, Boston, MA, USA

    Charles S. Day MD, MBA, Eric C. Makhni BS & Tamara D. Rozental MD

  3. Harvard Business School, Boston, MA, USA

    Eric C. Makhni BS

Authors
  1. Charles S. Day MD, MBA
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  2. Eric C. Makhni BS
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  3. Erika Mejia BA
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  4. Daniel E. Lage
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  5. Tamara D. Rozental MD
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Corresponding author

Correspondence to Charles S. Day MD, MBA.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This study was performed at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

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Day, C.S., Makhni, E.C., Mejia, E. et al. Carpal and Cubital Tunnel Syndrome: Who Gets Surgery?. Clin Orthop Relat Res 468, 1796–1803 (2010). https://doi.org/10.1007/s11999-009-1210-2

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  • DOI: https://doi.org/10.1007/s11999-009-1210-2

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