Maine carpal tunnel study: Outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort*,**

https://doi.org/10.1016/S0363-5023(98)80058-0Get rights and content

Aprospective, community-based, observational study of the outcome of surgical and nonoperative management was conducted. The study included 429 patients with carpal tunnel syndrome recruited in physicians' offices throughout Maine. Patients were assessed at baseline and at 6, 18, and 30 months following presentation using validated scales that measured symptom severity, functional status, and satisfaction. Seventy-seven percent of eligible survivors from the original cohort were monitored for 30 months. Surgically treated patients demonstrated improvements of 1.2 to 1.6 points on the 5-point Symptom Severity and Functional Status scale (23% to 45% improvement in scores), which persisted over the 30-month follow-up period. The nonoperatively managed patients showed little change in clinical status at 6, 18, and 30 months. While workers' compensation recipients had worse outcomes than nonrecipients, 36 of 68 (53%) workers' compensation recipients were completely or very satisfied with the results of the procedure 30 months after surgery. There were no significant differences in outcome between patients treated with endoscopic versus open carpal tunnel release. Among worker's compensation recipients, 12 of 68 (18%) surgical patients and 4 of 32 (13%) nonoperatively treated patients remained out of work because of carpal tunnel syndrome at 30 months. Thus, carpal tunnel surgery offered excellent symptom relief and functional improvement in this prospective community-based sample, irrespective of the surgical approach, even in workers' compensation recipients. Work absence remained high in both surgically and nonoperatively managed workers' compensation recipients.

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      Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity and affects more than 400 per 100,000 people each year.1 Surgical release of the transverse carpal ligament is an effective treatment of carpal tunnel syndrome with durable symptom improvement in long-term follow-up.2,3 Favorable results have been shown with both open4-8 and endoscopic9-11 carpal tunnel release (CTR) in the elderly patient population with short-term follow-up.

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    *

    Supported by National Institute of Health Grant No. AR36308. Agency for Health Care Policy and Research #5R18 HSO 6813-04, the Maine Medical Asessment Foundation, and an Investigator Award and Clinical Science Award from the Arthritis Foundation (to J.N.K.)

    **

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    1

    From the Division of Rheumatology, Immunology and Allergy, the Department of Orthopedic Surgery, and the Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; the Maine Medical Assessment Foundation and the Maine Health Information Center, Augusta, ME; and the Division of Rheumatology, Laval University, Ste Foy, Quebec, Canada.

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