A Light at the End of the Carpal Tunnel
April 19, 2000 -- Contrary to popular belief, carpal tunnel syndrome does
not always cause a permanent disability, and the symptoms can be treated, even
if the cause is work-related.
According to a study in the March issue of the American Journal of
Orthopedics, 82% of patients were able to return to full work status
following treatment, and another 18% could resume their jobs -- with some
"We found that the majority did return to the workplace. What we also
found was that patients who were treated surgically had a better outcome than
those treated with more conservative measures," says co-author Alon Garay,
MD, of the University of California, San Diego.
A research team of the Naval Medical Center in San Diego found that patients
with work-related carpal tunnel syndrome benefited from both conservative and
surgical treatment. However, workers treated with surgery had significantly
decreased employment disability and less disability than workers treated
conservatively, the researchers write.
The study evaluated case histories of 182 patients who were diagnosed with
work-related carpal tunnel syndrome. The severity of the condition varied
significantly among the patients, although most fell into the range of mild to
moderate. Of the 79 patients who were treated conservatively, about
three-quarters were able to return to their jobs and resume their normal work
By comparison, 87% of the 103 patients who underwent the surgical procedure
were able to return to work and resume normal capacity. None of the patients
experienced a total disability and all were able to return to work, even if
modifications were necessary.
"The idea that carpal tunnel syndrome automatically causes permanent
disability may be based on anecdotal evidence," says Garay. "And
anecdotal doesn't make for a study."
The results of this study are consistent with those of previous research,
which all show that people treated surgically tend to do better. Studies have
shown that patients who undergo the procedure known as "surgical
release" were six times more likely to have their symptoms resolved than
were those who had conservative measures.
"The present study supports surgical treatment for carpal tunnel
syndrome in the occupational setting," the authors write. It also suggests
that surgery may also be preferable from an economic standpoint, both for the
patient and industry.
"The surgery is a very minor procedure and the results are usually
spectacular. If you don't get a good result from surgery, then the diagnosis
may have been wrong, or else the patient waited too long, and nerve damage has
already occurred," says Jeffrey Malka, MD, associate professor at
Georgetown University and chairman of the department of orthopaedic surgery at
Inova Fairfax Hospital in Falls Church, Va.
"But carpal tunnel is very variable and you can't lump all cases
together," Malka says. "You have to take into account the specific
patient and what the symptoms are. You want to do the least you can do to
benefit the person in the best way." Malka reviewed the study for