Carpal and cubital tunnel syndrome: who gets surgery?

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.

Fig. 1

A chart shows the distribution of diagnoses among the patients with carpal and/or cubital tunnel syndrome. While 69% of patients had a single neuropathy, 31% had more than one diagnosis. Unilateral carpal tunnel syndrome was the most common neuropathy (58%), while bilateral carpal tunnel syndrome was the second most common (23%). No patients had contralateral carpal and cubital tunnel syndrome.

Fig. 2

A graph shows the percentage of patients receiving at least one surgery for carpal or cubital tunnel syndrome by number of neuropathies. Patients with more than one neuropathy were more likely to receive surgery than patients with only one neuropathy (61% versus 45%).

Fig. 3

A graph shows the percentage of patients who underwent at least one surgery for carpal or cubital tunnel syndrome by age group. The rates of operative treatment increased with increasing age. Only 28% of Group I patients underwent at least one surgery, compared to 57% and 66% of Groups II and III, respectively.

Fig. 4

A graph shows the percentage of patients with carpal or cubital tunnel syndrome who were female. More patients with carpal tunnel syndrome were female (68%) than patients with cubital tunnel syndrome (47%).

Fig. 5A–B

These graphs show the percentage of patients receiving at least one surgery for carpal or cubital tunnel syndrome by gender. (A) Among all patients, there was no gender difference in the surgical rates between males and females (52% versus 44%). (B) However, among multiple-diagnosis (Dx) patients, there were more male patients than female patients (63% versus 41%).

Fig. 6

A graph shows the average wait time to surgery by gender, number of neuropathies, Workers Compensation status. The average wait time to surgery for all patients was 124 days. There were no differences in the wait times to surgery between single- and multiple-diagnosis patients (114 versus 141 days) and between patients with or without Workers Compensation (179 versus 117 days).

Fig. 7A–B

These graphs show the percentage of patients who refused surgery when it was recommended by surgeon by gender and Workers Compensation status. There were no differences observed in patient refusal of surgery (A) between male and female patients (53% versus 49%) and (B) between patients with (WC) or without Workers Compensation (Non-WC) (36% versus 51%).