Affiliations: Center for Disability Research, Liberty Mutual
Research Institute for Safety, Hopkinton, MA, USA
Note: [] Address for correspondence: Radoslaw Wasiak, Liberty Mutual
Research Institute for Safety, Center for Disability Research, 71 Frankland
Road, Hopkinton, MA 01748, USA. Tel.: +1 508 497 0242; Fax: +1 508 435 8136;
E-mail: radoslaw.wasiak@libertymutual.com
Abstract: Carpal tunnel syndrome (CTS) is often work-related and associated
with prolonged disability. While surgical treatment is common, an alternative
endoscopic procedure has been promoted as a way of achieving better outcomes.
However, little is known about typical use of the procedure and whether it
actually achieves outcomes in community settings. From workers' compensation
claims reported to an insurer in six jurisdictions during 1995–1999, we
identified 1697 individuals with a single CTS surgery, 17% were treated using
the endoscopic procedure. Bivariate analyses of post-surgical outcomes
demonstrated that post-surgical work disability was shorter for those with
endoscopic procedures (median 27 vs. 34 days, mean 62 vs. 85 days; p<
0.01). Medical costs following the procedure were also lower in the case of
endoscopic procedure for those with any post-surgical medical costs (median
$1,201 vs. $1,717, mean $5,733 vs. $7,084; p<
0.01). However, controlling for jurisdiction and other factors, these
differences disappeared, suggesting that in CTS the type of care received was
not a major determinant of outcomes. These findings reinforce the importance of
community-based evaluations which include potential confounders to accurately
evaluate the impact of medical technologies on work disability in occupational
conditions.
Keywords: Carpal tunnel, endoscopic release, return to work, medical costs, workers' compensation
