Carpal and cubital tunnel syndrome: who gets surgery?
BACKGROUND
Despite the prevalence of carpal and cubital tunnel syndrome, and relief of symptoms following timely surgical release, it is unclear how nonclinical patient characteristics affect disease management.


OBJECTIVE
We examined the effects of a variety of factors, such as age, gender, and socioeconomic status on the management of both carpal and cubital tunnel syndromes.


METHODS
We retrospectively reviewed the records of all 273 patients seen by two hand surgeons with a diagnosis of either carpal or cubital tunnel syndrome between January 2005 and January 2007. Demographic, clinical (diagnosis, treatment), and socioeconomic (insurance type, median income) information was collected. Census data (2000) were used to collect information on median household income. The average age was 52 years (range, 19-87 years), and 65% of the patients were women (n = 178). Eighteen patients had Workers Compensation. Of the 273 patients, 86 (32%) had two or more diagnoses.


RESULTS
Among patients with carpal tunnel syndrome, there was a higher proportion of female patients compared to male patients (68% versus 32%); male patients with multiple neuropathies had higher rates of surgery than their female counterparts (63% versus 41%). Only increasing age was associated with increasing likelihood of surgery. Among multiple-diagnosis patients, those with Workers Compensation (n = 6) had higher wait times for surgery than their counterparts (n = 46) (126 days versus 26 days).


CONCLUSIONS
Patient age was the most important predictor of surgical release, and among those with multiple neuropathies, male patients were more likely to have surgery than female patients. Patients with Workers Compensation may experience long wait times to surgery.


METHODS
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Day
Charles S
CS
Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA. cday1@bidmc.harvard.edu
Makhni
Eric C
EC
Mejia
Erika
E
Lage
Daniel E
DE
Rozental
Tamara D
TD
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D020430:Cubital Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D012923:Social Class; D014850:Waiting Lists; D014942:Workers' Compensation / Q000706:statistics & numerical data; D055815:Young Adult