title: Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: a 25-year perspective.
abstract: OBJECTIVE
  In 1987, Duncan et al.(1) reported on a survey of the members of the American Society for the Surgery of the Hand (ASSH) about their practices in treating carpal tunnel syndrome (CTS). To better understand changes in the treatment of CTS over the past 25 years, we repeated the survey while incorporating present-day controversies.
  
  
  METHODS
  With the approval of the ASSH, an Internet-based survey was e-mailed to all members of the Society. This included 33 primary questions focusing on 4 areas of study: surgeon demographic information, nonoperative treatment, surgical technique, and postoperative care. A total of 1,463 surveys were delivered and 707 surveys were completed and returned, for a response rate of 48%. Responses were compared with the responses from Duncan et al. published 25 years ago.(1)
  
  
  RESULTS
  In contrast to the practice patterns identified 25 years ago, this survey identified several changes in current clinical practices including the following statistically significant findings: Preoperatively, surgeons have increased the use of splints and corticosteroid injections, treat nonoperatively longer, and have narrowed their surgical indications. Regarding surgical technique, surgeons now are using tourniquets less, infiltrate the carpal tunnel with corticosteroids less, and place deep sutures less often. Furthermore, performing concomitant procedures along with release of the transverse carpal ligament has decreased. Orthotic use and duration postoperatively also decreased.
  
  
  CONCLUSIONS
  Although significant differences are evident between management of CTS between 1987 and 2011, no consensus has emerged.
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. bikeberry@comcast.net
authors.forename: Charles F
authors.initials: CF
authors.lastname: Leinberry
authors.forename: Michael
authors.initials: M
authors.lastname: Rivlin
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.forename: Pedro
authors.initials: P
authors.lastname: Beredjiklian
authors.forename: Jonas L
authors.initials: JL
authors.lastname: Matzon
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Hutchinson
mesh_terms: D000765:Anesthesia, Conduction / Q000706:statistics & numerical data; D000772:Anesthesia, Local / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002349:Carpal Tunnel Syndrome / Q000628:therapy*; D004568:Electrodiagnosis / Q000706:statistics & numerical data; D004724:Endoscopy / Q000706:statistics & numerical data; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009407:Nerve Block / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends*; D012955:Societies, Medical; D013165:Splints / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014111:Tourniquets / Q000706:statistics & numerical data; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids