What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance

Abstract

Background Treatment of carpal tunnel syndrome (CTS) in commercially insured patients across the spectrum of provider types has rarely been described. Objective The purpose of this study was to describe patterns of types of treatment for patients with CTS using a large commercial insurance database. Design Retrospective cohort descriptive study Setting Administrative health data from the Clinformatics® Datamart (OptumInsight, Eden Prairie, MN). Patients Adults with a primary diagnosis of CTS seen from between January, 2010 to December, 2012 who had a total of 48 months of continuous data (12 months prior to diagnosis and 36 months after diagnosis) (n = 24,931). Outcomes Frequency of types of treatment (heat, manual therapy, positioning, steroid, stretching, surgery) by number of treatments, number of visits, provider type, and characteristics. Results Fifty-three percent of patients received no reported treatment and 50.4% had no additional visits. Surgery (42.5%) and positioning (39.8%) were the most frequent single treatments. Patients who were seen by orthopedist for their first visit more frequently received some treatment (75.1%) and at least one additional visit (74.1%) compared to those seen by general practitioners (59.5%, 57.5% respectively) or other providers (65.4%, 68.4 respectively). Orthopedists more frequently prescribed positioning devices (26.8%) and surgery (36.8%) than general practitioners (18.8%, 14.1%, respectively) or other providers (15.7%, 19.7%, respectively). Older adults more frequently had CTS surgery as did people who lived in the Midwest. Overall, only 24% of CTS patients had surgery. Conclusions For more than half of patients with CTS no treatment was provided after an initial visit. Surgery rates were much lower than what has previously been reported in the literature. Generally, patients with CTS receive treatments that are supported by current treatment guidelines.

The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years

“…The need to discontinue treatment due to skin irritation or orthosis intolerance is reported by less than 1% of patients [1,6,[22][23][24][25][26][27]. Due to the above, the use of kinesiotaping may be an alternative method of CTS treatment, the effects of which are similar to immobilization in an orthosis.…”

Treatment Preferences of Physical Therapists in Management of Carpal Tunnel Syndrome: A Cross Sectional Survey

“…As CTS is highly prevalent among all compression neuropathies 5 , treatment guidelines suggest that management should be based on the duration and severity of the CTS 6 . Patients who do not experience severe symptoms and only mild to moderate functional limitations are managed through physical therapy treatment that includes cryotherapy, nerve mobilization, therapeutic ultrasound, bracing, education and home exercise plans 4,6,7 . Conservative treatment was recommended initially by the American Academy of Neurology.…”

Predictors and Variation in Steroid Injection Use for Carpal Tunnel Syndrome from a Multicenter Quality Collaborative

“…Orthopedists were more likely to prescribe steroid injections than general practitioners or other providers. 15 In addition, in a study of the Veterans Affairs population, there was considerable facility-level variation in the use of steroid injections in patients who received surgery compared with nonoperative patients. 16 In this study, we used data from a multicenter hand surgery quality collaborative to determine the predictors of and variation in steroid injection use by treating hand surgeons.…”

“…Orthopedists were more likely to prescribe steroid injections than general practitioners or other providers. 15 In addition, in a study of the Veterans Affairs population, there was considerable facility-level variation in the use of steroid injections in patients who received surgery compared with nonoperative patients. 16…”