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Scientific Articles   |    
Factors Affecting Willingness to Undergo Carpal Tunnel Release
Hyun Sik Gong, MD, PhD1; Goo Hyun Baek, MD, PhD1; Joo Han Oh, MD, PhD1; Young Ho Lee, MD, PhD1; Suk Ha Jeon, MD1; Moon Sang Chung, MD, PhD1
1 Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. E-mail address for M.S. Chung: moonsang@snu.ac.kr
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Sep 01;91(9):2130-2136. doi: 10.2106/JBJS.H.01221
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Abstract

Background: Factors regarding patient willingness to undergo or avoid joint replacement have been studied; however, these factors have not been studied in patients with carpal tunnel syndrome. To further understand the aspects that are important for a patient with carpal tunnel syndrome in deciding whether to have surgery, we identified factors that affect this decision in women and that are not related to Workers' Compensation status.

Methods: We retrospectively reviewed 282 female patients with electrophysiologically confirmed carpal tunnel syndrome without a known cause who were recommended for carpal tunnel release by a single hand surgeon in a tertiary medical setting. Of those, thirty-six female patients who were not entitled to Workers' Compensation canceled the operation during the waiting period, which averaged four weeks. Thirty-three of them were surveyed with a questionnaire sent by mail, and eighteen completed surveys were reviewed at a mean follow-up of thirty-two months. Furthermore, seventy female patients who underwent carpal tunnel release were randomly sampled, and thirty-eight patients completed the survey. The operation and cancellation groups were compared with regard to the reasons for choosing or canceling surgery.

Results: The groups were similar with regard to age, sociodemographic variables, follow-up length, initial electrophysiological findings, and functional status. The highest-ranked reason for choosing surgery was symptom severity rather than fear of progression or a positive electrodiagnostic result. Those who canceled the operation rated symptom improvement during the waiting period as the leading reason for doing so, but they were also concerned about transient weakness, the financial burden, and a scar or pillar pain. Disease persistence or recurrence was the issue of most concern in both groups. At the time of the final review, the functional status was significantly improved in both groups and no significant difference between the groups was detected.

Conclusions: Women with carpal tunnel syndrome report that subjective symptom severity is the most important reason for undergoing surgery. Understanding this and other patient concerns may help physicians during patient-oriented consultation and decision-making. In particular, recommendations for carpal tunnel release on the basis of symptoms are reasonable from the perspective of the patient who has carpal tunnel syndrome without a known cause.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Moon Sang Chung, MD, PhD
    Posted on October 10, 2009
    Dr. Chung and colleagues respond to Mr. Papanna
    Seoul National University Hospital, Seongnam, South Korea

    We thank Mr. Papanna for his interest in our paper. We included only those patients with idiopathic carpal tunnel syndrome, i.e. carpal tunnel syndrome, without a known cause. We excluded those who had wrist or forearm fractures, or pre-existing complex regional pain syndrome. We did not mention those conditions in our article, but we feel Mr. Papanna's point is a good one, and those diagnoses deserved to be mentioned. We routinely use a tourniquet during the operation for a short duration of about 5 minutes and we suture the incision after the tourniquet is released.

    Madhavan Chikkapapanna Papanna
    Posted on September 29, 2009
    Good Article with Severe Limitations
    Luton and Dunstable Hospital NHS Foundation Trust, Luton, United Kingdom

    To the Editor:

    I read the article by Gong et al. (1) with great interest. I would like to ask the authors if there were any patients in the study who had wrist or forearm fractures, if any subject had pre-existing complex regional pain syndrome and, lastly, whether a tourniquet was used during the operation.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

    Reference

    1. Gong HS, Baek GH, Oh JH, Lee YH, Jeon SH, Chung MS. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am. 2009;91:2130-6.

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