title: Work-related carpal tunnel syndrome in Washington State workers' compensation: utilization of surgery and the duration of lost work.
abstract: BACKGROUND
  Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability.
  
  
  METHODS
  This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n = 8,224) filed during 1990-1994 (followed through 2000) and receiving lost-work compensation.
  
  
  RESULTS
  Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P < 0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery.
  
  
  CONCLUSIONS
  There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution.
authors.affiliation: Department of Environmental and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195-7234, USA. bdaniell@u.washington.edu
authors.forename: William E
authors.initials: WE
authors.lastname: Daniell
authors.forename: Deborah
authors.initials: D
authors.lastname: Fulton-Kehoe
authors.forename: Gary M
authors.initials: GM
authors.lastname: Franklin
mesh_terms: D000328:Adult; D001182:Arthroscopy; D002349:Carpal Tunnel Syndrome / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000534:rehabilitation; D020127:Recovery of Function; D012050:Rehabilitation, Vocational; D012189:Retrospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data*; D014600:Utilization Review; D014861:Washington; D014942:Workers' Compensation / Q000706:statistics & numerical data*