Abstract
Background
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting the upper extremity, yet evidence-based guidelines for its diagnosis and treatment are lacking. We set out to expose any potential discrepancies in CTS practice attitudes based on surgeon’s academic background, residency training, clinical experience, and other factors.
Methods
This was an online survey-based study. Members of the American Association for Hand Surgery (AAHS) were sent an electronic mail request (n = 817). The online questionnaire consisted of 12 questions that queried surgeons’ approaches to the diagnosis as well as operative and non-operative management of carpal tunnel syndrome.
Results
One hundred twenty-three surgeons responded to the survey (15.1 %). The locations of surgical practices varied within the United States and beyond. Most respondents were either orthopedic or plastic surgeons. With respect to practice duration, 15.4 % had been in practice for 5 years or less, 30.9 % of the respondents had been in practice between 6 and 15 years, 30.9 % had been in practice between 16 and 25 years, and 26.8 % had been in practice for more than 25 years. The most notable interspecialty differences were related to the use of operative antibiotics and the surgical approach. Plastic surgeons were less likely to recommend antibiotic use during surgery and more likely to utilize an open extensile approach during surgical release. Younger surgeons were more likely to employ a mini-open approach for carpal tunnel release.
Conclusions
We conclude that background training and generational differences contribute to the varied approaches observed in the diagnosis and management of CTS.
Similar content being viewed by others
References
Duncan KH, Lewis RC, Foreman KA, et al. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: results of a questionnaire. J Hand Surg. 1987;12A:384–91.
Ebskov LB, Boeckstyns ME, Sorensen AI. Operative treatment of carpal tunnel syndrome in Denmark. Results of a questionnaire. J Hand Surg. 1997;22B:761–3.
ElMaraghy A, Devereaux MW. Variability in the surgical management of carpal tunnel syndrome: implications for the effective use of healthcare resources. Healthc Q. 2009;12:85–91.
Henry SL, Hubbard BA, Concannon MJ. Splinting after carpal tunnel release: current practice, scientific evidence, and trends. Plast Reconstr Surg. 2008;122:1095–9.
Payatakes AH, Zagoreos NP, Fedorcik GG, et al. Current practice of microsurgery by members of the American Society for Surgery of the Hand. J Hand Surg. 2007;32(A):541–7.
Phalen GS. Spontaneous compression of the median nerve at the wrist. J Am Med Assoc. 1951;145:1128–33.
Phalen GS, Gardner WJ, La Londe AA. Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Surg. 1950;32A:109–12.
Phalen GS, Kendrick JI. Compression neuropathy of the median nerve in the carpal tunnel. J Am Med Assoc. 1957;164:524–30.
Wolf JM, Delaronde S. Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg. 2012;37(A):77–82.
Acknowledgments
We would like to thank the AAHS board and administration for assisting with the study design and survey distribution.
Conflicts of interest
The authors declare that they have no conflicts of interests.
Funding
There was no external funding for this study.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Shin, E.K., Bachoura, A., Jacoby, S.M. et al. Treatment of carpal tunnel syndrome by members of the American Association for Hand Surgery. HAND 7, 351–356 (2012). https://doi.org/10.1007/s11552-012-9455-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11552-012-9455-8