Carpal tunnel surgery outcomes in workers: Effect of workers' compensation status

Higgs, Philip; Edwards, Dorothy Farrar; Martin, David S.; Weeks, Paul M.

doi:10.1016/s0363-5023(05)80086-3

Cited by 80 publications

(42 citation statements)

References 20 publications

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“…57 Most of these symptoms are expected to resolve over time (eg, within 3 to 6 months following surgery). But, Higgs et al 37 found that 118 of 166 patients studied had some residual symptoms at 18 months following CTR.…”

Section: Consequences Of Ctr: What To Expect Following Surgerymentioning

confidence: 96%

Conservative Interventions for Carpal Tunnel Syndrome

Michlovitz¹

2004

J Orthop Sports Phys Ther

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The assessment and conservative interventions in patients with carpal tunnel syndrome (CTS) are described in this paper. Information about surgical procedures and postoperative care has also been included. It is difficult to make definitive conclusions about the literature regarding success of treatment for CTS due to variations in outcome measures, severity of CTS, and inconsistencies in duration, dosage, and follow-up time for interventions. Based on what is known to date, this author recommends that patients with mild or moderate CTS be provided with a conservative program of splinting the wrist in neutral for nocturnal wear. In addition, intermittent exercise (nerve-gliding exercises) and activity modification, including avoidance of protracted periods of sustained gripping activities and awkward wrist positions, can be useful. This conservative program may be complemented by pain-relieving modalities during times of activity and supplemental participation in other exercise such as yoga. If symptoms are not relieved to the satisfaction of the patient, or they recur, then it is incumbent upon the therapist to refer the patient to a hand surgeon for injection or possible surgical decompression.

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Section: Consequences Of Ctr: What To Expect Following Surgerymentioning

confidence: 96%

Conservative Interventions for Carpal Tunnel Syndrome

Michlovitz¹

2004

J Orthop Sports Phys Ther

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“…When a comparison was made by type of insurance reimbursement, patients who received WC required longer to recuperate and were more likely to require therapy than those who did not (7,9,10,(12)(13)(14)(15)(16)(17). Ninety-seven per cent of our short incision OHIP patients (171 of 177 hands) resumed ADL within 28 days.…”

Section: Resultsmentioning

confidence: 93%

“…Other studies reported a range of 33% to 63% within 28 days (7,8,14), a mean of 29.2 to 57.6 days (7,9,10,14,15) or a median of 57 to 71 days (12,14). The above studies were conducted in the United States, where many authors suspect that secondary gain is a factor in the recovery of WC patients (12,13,16,17). In Ontario, the Workers' Compensation Act (18) obligates employers to reinstate injured workers in their previous job or a suitable alternative, whenever possible.…”

Section: Resultsmentioning

confidence: 96%

Open carpal tunnel release: Comparison of a long versus short incision

Kruger¹,

Rebot²

1998

CAN J PLAST SURG

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A review of our patients who had been treated with open carpal tunnel release (OCTR) undertaken in 1991 revealed that 78% had an uneventful course of recovery, resuming full function within two to four weeks, and that 25% required out-patient rehabilitation due to the persistence and magnitude of their symptoms three to four weeks postoperatively. Resumption of activities of daily living (ADL) was delayed by weakness, peri-incisional tenderness, restricted range of movement and swelling.In an effort to decrease postoperative morbidity and shorten recovery time, our surgical protocol was re-examined. Decreased postoperative discomfort and shorter recovery A total of 225 adults with carpal tunnel release of 313 wrists were studied to compare the outcome of a long (at least 3.5 cm) with that of a short (2.0 cm or less) incision technique. The two groups were compared for postoperative complaints, length of time until full function was regained, rate of referral to rehabilitation and the effect of Workers' Compensation status. The surgical technique and rehabilitation protocol are described. The number and severity of postoperative complaints were significantly reduced in the short incision group. In the non-Workers' Compensation group, 96% of short incision patients resumed full function within 28 days. This finding compares favourably with published results for endoscopic release, and is superior to results obtained with the long incision. Workers' Compensation patients required longer to recuperate, with 78% regaining full function within 28 days. Of those with Workers' Compensation, 47% of the long incision group and 27% of the short incision group required out-patient therapy. For the non-Workers' Compensation group, this percentage decreased to 21% of those with the long incision and 3% with the short incision. A history of vocational or avocational repetitive motion patterns was the most common indicator for therapy and accounted for 67% of rehabilitation referrals. Key Words: Adult, Carpal tunnel release, Median nerve, Occupational therapy, Physical therapy, Treatment outcomeDégagement ouvert du canal carpien : comparaison d'une incision longue versus courte RÉSUMÉ : En tout, 225 adultes ayant subi un dégagement du canal carpien, totalisant 313 poignets, ont été étudiés afin de comparer les résultats d'une technique d'incision longue (au moins 3,5 cm) versus courte (2,0 cm ou moins). Les deux groupes ont été comparés au chapitre des plaintes postopératoires, du temps de retour à un fonctionnement normal, du taux de demandes auprès des programmes de réadaptation et de l'effet sur la compensation par la CSST. La technique chirurgicale et le protocole de réadaptation sont décrits. Le nombre et la gravité des problèmes postopératoires ont été significativement moindres dans le groupe ayant subi l'incision courte. Pour le groupe non inscrit à la CSST, 96 % des patients ayant subi une incision courte ont retrouvé un fonctionnement normal en 28 jours. Ces résultats se comparent favorablement aux résultats publiés a...

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“…However, one of the most reliable of findings in the pain management field is that patients being treated for a given problem under a workers compensation scheme have poorer outcomes than those being treated for the same problem in a non-compensation environment [8,9]. This finding applies to a range of different surgical procedures, physical therapies, self management training and medication regimes [6,[10][11][12]. A meta-analysis by Rohling et al [2] compared the effect of disability compensation on treatment efficacy in 136 controlled studies, totalling some 7,000 patients.…”

Section: Treatment Outcomes In Compensable and Non-compensable Injuriesmentioning

confidence: 99%

Pain management in the context of workers compensation: a case study

Newton‐John¹,

McDonald²

2012

Behav. Med. Pract. Policy Res.

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The clinical management of chronic pain is a biopsychosocial challenge in itself; however, when the pain occurs in the context of workers compensation, there is even greater clinical complexity. A review of the literature shows that patients being treated for chronic pain under workers compensation are generally more distressed and have poorer outcomes both clinically and vocationally than non-compensated patients. A range of factors is identified to explain these differences, including operation of the system itself. However, a case study is presented involving a 49-yearold woman with chronic neck pain, whose clinical history illustrates how workers compensation can negatively influence outcomes, but where successful rehabilitation is also possible.

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Carpal tunnel surgery outcomes in workers: Effect of workers' compensation status

Cited by 80 publications

References 20 publications

Conservative Interventions for Carpal Tunnel Syndrome

Conservative Interventions for Carpal Tunnel Syndrome

Open carpal tunnel release: Comparison of a long versus short incision

Pain management in the context of workers compensation: a case study

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