A Light at the End of the Carpal Tunnel

From the WebMD Archives

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 modifications.

"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 capacity.

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 WebMD.

"Surgical treatment is superior to any other treatment, across the board. But if a person has only minimal symptoms, they may be able to avoid it, or at least delay surgery," says Gregory Hanker, MD. "If they have moderate to severe symptoms, the vast majority of people who get [conservative treatment] will worsen over time. Those people almost always need surgery." Hanker, who also reviewed the study for WebMD, is a hand surgeon and assistant clinical professor at the University of Southern California.

Hanker says the recurrence rate is low following surgery, but, most important, patients need to be educated about the nature of disease. "You want to educate them how to lessen stress on their hands. Basically, it's common sense. Avoid those things that hurt, do those things that don't."

This study was sponsored by the Navy's Chief Bureau of Medicine and Surgery.

Vital Information:

  • The idea that carpal tunnel syndrome is a permanent disability that cannot be reversed may be a myth, according to a new study.
  • Most carpal tunnel patients who are treated are able to return to their jobs and resume a normal work capacity, even if modifications are necessary.
  • Those who undergo a surgical procedure are more likely to have their symptoms resolved compared to those who undergo other treatments, and the recurrence rate is low.