Treatment of Carpal Tunnel Syndrome by Members of the American Association for Hand Surgery

Abstract

Background

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting the upper extremity, yet evidence-based guidelines for its diagnosis and treatment are lacking. We set out to expose any potential discrepancies in CTS practice attitudes based on surgeon's academic background, residency training, clinical experience, and other factors.

Methods

This was an online survey-based study. Members of the American Association for Hand Surgery (AAHS) were sent an electronic mail request (n=817). The online questionnaire consisted of 12 questions that queried surgeons' approaches to the diagnosis as well as operative and non-operative management of carpal tunnel syndrome.

Results

One hundred twenty-three surgeons responded to the survey (15.1 %). The locations of surgical practices varied within the United States and beyond. Most respondents were either orthopedic or plastic surgeons. With respect to practice duration, 15.4 % had been in practice for 5 years or less, 30.9 % of the respondents had been in practice between 6 and 15 years, 30.9 % had been in practice between 16 and 25 years, and 26.8 % had been in practice for more than 25 years. The most notable interspecialty differences were related to the use of operative antibiotics and the surgical approach. Plastic surgeons were less likely to recommend antibiotic use during surgery and more likely to utilize an open extensile approach during surgical release. Younger surgeons were more likely to employ a mini-open approach for carpal tunnel release.

Conclusions

We conclude that background training and generational differences contribute to the varied approaches observed in the diagnosis and management of CTS.