Ramazzini; Blog on work and health by Annet Lenderink

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CTS: surgery and return to work

CTS_surgeryWork-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability.  To characterize associations between utilization of CTS surgery and duration of lost work 8224 workers’ compensation claims filed during 1990-1994 were studied. 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.

Work-related carpal tunnel syndrome in Washington State workers’ compensation: Utilization of surgery and the duration of lost work
William E. Daniell, MD, MPH, Deborah Fulton-Kehoe, MPH, PhD , Gary M. Franklin, MD, MPH Am. J. Ind. Med. 2009

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,
  • 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.

Filed under: Compensation, Musculoskeletal problems, Physical load, Sickness absence, , ,

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