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. 2019 Jun;8(3):209-214.
doi: 10.1055/s-0039-1678674. Epub 2019 Feb 27.

National Trends in the Diagnosis of CRPS after Open and Endoscopic Carpal Tunnel Release

Kevin Mertz  1 , Jeremy Trunzter  1 , Edward Wu  1 , James Barnes  2 , Sara L Eppler  1 , Robin N Kamal  1
Affiliations

National Trends in the Diagnosis of CRPS after Open and Endoscopic Carpal Tunnel Release

Kevin Mertz et al. J Wrist Surg. 2019 Jun.

Abstract

Background Complex regional pain syndrome (CRPS) occurs in 2 to 8% of patients that receive open or endoscopic carpal tunnel release (CTR). Because CRPS is difficult to treat after onset, identifying risk factors can inform prevention. We determined the incidence of CRPS following open and endoscopic CTR using a national claims database. We also examined whether psychosocial conditions were associated with CRPS after CTR. Methods We accessed insurance claims using diagnostic and procedural codes. We calculated the incidence of CRPS following open carpal tunnel release and endoscopic carpal tunnel release within 1 year. The response variable was the presence of CRPS after CTR. Explanatory variables included procedure type, age, gender, and preoperative diagnosis of anxiety or depression. Results The number of open CTRs (85% of total) outweighs the number of endoscopic procedures. In younger patients, the percentage of endoscopic CTRs is increasing. Rates of CRPS are nearly identical between surgery types for both privately insured (0.3%) and Medicare patients (0.1%). Middle aged (range: 40-64 years) and female patients had significantly higher rates of CRPS than did the general population. Preoperative psychosocial conditions did not correlate with the presence of CRPS in surgical patients. Clinical Relevance The decision between endoscopic and open CTR should not be made out of concern for development of CRPS postsurgery, as rates are low and similar for both procedures. Rates of CRPS found in this study are much lower than rates found in previous studies, indicating inconsistency in diagnosis and reporting or generalizability of prior work. Preoperative psychosocial disorders and CRPS are unrelated.

Keywords: carpal tunnel release; carpal tunnel syndrome; complex regional pain syndrome; quality.

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Conflict of interest statement

Conflict of Interest Author J.B. was supported by the Department of Veterans Affairs (VA) Office of Academic Affiliations Advanced Fellowship in Health Services Research and Development (HSR&D). None of the other authors have received funding or financial support for this project nor have any potential sources of conflict of interest.

Figures

Fig. 1
Fig. 1
Pearl Diver command methodology with associated ICD-9, CPT, and Physpec codes. Exclusion diagnoses listed as well. CPT, Current Procedural Terminology; CRPS, complex regional pain syndrome; CTR, carpal tunnel release; ICD-9, International Classification of Disease, 9th Edition.
Fig. 2
Fig. 2
Year-by-year trends of open and endoscopic CTR, Humana data. CTR, carpal tunnel release.
Fig. 3
Fig. 3
Year–by-year trends of open and endoscopic CTR with subsequent CRPS diagnosis, Humana (private insurance) data. CRPS, complex regional pain syndrome; CTR, carpal tunnel release.
Fig. 4
Fig. 4
Year-by-year trends of open and endoscopic CTR, Medicare data. CTR, carpal tunnel release.
Fig. 5
Fig. 5
Year-by-year trends of open and endocopic CTR with subsequent CRPS diagnosis, Medicare data. CRPS, complex regional pain syndrome; CTR, carpal tunnel release.
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