Affiliations: Center for Disability Research, Liberty Mutual
Research Institute for Safety, Hopkinton, MA, USA | Occupational Health Program, Department of
Environmental Health, Harvard School of Public Health, Boston, MA, USA | Department of Family Medicine and Community Health,
University of Massachusetts Medical School, Worcester, MA, USA | University of Massachusetts, Amherst, MA, USA
Note: [] Address for correspondence: Radoslaw Wasiak, Liberty Mutual
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: Medical treatment of compensated work-related conditions has two
objectives-improve injured workers' health status and allow safe and sustained
return to work (RTW). Theoretically, the choice of treatment method should be
based primarily on these objectives. Surgical treatment of work-related carpal
tunnel syndrome (CTS) provides an opportunity to evaluate whether this occurs.
The traditional method of open release has been complemented by an endoscopic
procedure, particularly useful in work-related cases due to the anticipated
benefit of earlier RTW. The objective of this study was to investigate the
differences in surgical treatment for work-related CTS across eight US workers'
compensation (WC) jurisdictions, and the factors associated with these
differences. From all WC claims reported to a single insurer during the
1995–1999 period, we identified individuals with a one or two surgical
procedures for work-related CTS. Among selected
individuals (n=4,421), about 20% were treated using the
endoscopic procedure; this percentage had a ten-fold variation across the eight
jurisdictions. However, utilization of endoscopic release did not increase
during the study period, despite reports of better RTW outcomes. The highly
jurisdictional nature of the US WC system, with significant differences in
reimbursement levels for endoscopic procedures, and geographical differences in
medical training were among the potential contributors to the observed
variation in utilization.
Keywords: Carpal tunnel, endoscopic release, utilization of medical care, workers' compensation, return to work
