Carpal tunnel syndrome (CTS) is a common cause of upper extremity discomfort and disability. Expenses related to surgical therapy (carpal tunnel release) exceed $1 billion annually. Nevertheless, the epidemiology of carpal tunnel release has not been studied, and there are no large prospective studies of the outcome of conservative and surgical therapy for CTS. The overall goal of this study is to evaluate and ultimately improve the outcome of conservative and surgical therapy for CTS.
Specific aims i nclude (1) analysis of variations in the rates of carpal tunnel release across small geographic regions in Maine; and (2) evaluation of the outcome of conservative and surgical therapy in a cohort of patients, and identification of factors associated with poor outcomes. The analysis of variations in rates of surgery will utilize data maintained by the Maine Health Information Center. Marked geographic variation in surgical rates often reflects uncertainties about the appropriate indications for surgery. The prospective cohort study will involve 280 patients with CTS treated surgically and 150 treated conservatively. Patients will be recruited from physicians' offices throughout Maine. Demographic, clinical health status, physical examination, and treatment data will be obtained at enrollment, and outcome data on upper extremity pain, paresthesia, weakness, motor function, and patient satisfaction will be obtained at 6, 18, and 30 month follow-up. Analyses will characterize the outcome of conservative and surgical therapy and identify risk factors for poor outcomes. Data from this study will be useful in developing guidelines about the choice of surgical vs. conservative therapy for CTS.
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