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

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.

The Association of Insurance Status and Complications After Carpal Tunnel Release

“…This finding may support the use of perioperative antibiotic prophylaxis in this cohort. Previous studies have reported post-CTR CRPS rates of between 2% and 8%, 12,30-32 which is significantly higher than our finding of 0.21%; it is important to note that, however, some of the randomized controlled studies used comparatively smaller sample sizes of often less than 200 patients. Wound breakdown/dehiscence rates in our study (0.43%) were similar to previous estimates in the literature of 0.2%.…”

Differences in incidence rate and onset timing of undiagnosed finger symptom among shoulder surgeries related to complex regional pain syndrome

“…Previous studies reported that the individual factors related to CRPS were age (23), female sex (10,24), preoperative pain (25), preoperative contracture (3), and fracture (6). In our investigation, none of these factors was statistically significantly different between groups U and N. Further, although the odds ratio for developing UDFS was extremely high in patients with fractures, no significant difference was found in logistic regression analysis, probably because the sample size was too small.…”

“…Regarding the pathophysiology of CRPS, Groeneweg et al reported that endothelial damage caused by surgical incision triggers vasoconstriction that induces CRPS (7,8). On the other hand, Mertz et al reported no significant difference in the incidence rate of CRPS between endoscopic and open release procedures for carpal tunnel release (24). In their retrospective cohort study on distal radial fractures, Wang et al reported that use of a volar locking plate lowered the incidence rate of CRPS as compared with external fixation (27).…”

Complex Regional Pain Syndrome: A Comprehensive Review

“…Extremity injuries, such as fractures or sprains, surgery, and carpal tunnel syndrome have been the most commonly reported inciting events leading to CRPS [1][2][3]15]. In a recent analysis of 1043 patients with CRPS, the most common primary causes were fractures (42%), blunt traumatic injuries excluding fractures (e.g., sprains) (21%), surgery (12%), and carpal tunnel syndrome (7%), while 7% had no clear precipitating event [1].…”

“…Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by hyperalgesia and allodynia, commonly involving the limbs. It frequently develops after extremity trauma or surgery [1][2][3]. The pathophysiology underlying the development of CRPS is still being explored, but the disorder is believed to result from central and peripheral nervous system dysfunction [4].…”