Patients with OA may use more health care resources after carpal tunnel release
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Key takeaways:
- Patients with arthritis had longer follow-up in the hand clinic after carpal tunnel release.
- After carpal tunnel release, symptoms may persist longer in patients with arthritis.
Results showed patients with osteoarthritis who underwent carpal tunnel release may use more health care resources and experience more severe and persistent carpal tunnel syndrome symptoms vs. patients without arthritis.
“Patients with preexisting hand and/or wrist arthritis are more likely to have a longer recovery after carpal tunnel release as compared to those who do not,” study co-author Brett F. Michelotti, MD, told Healio. “This means that the hand and wrist may swell more, hurt more, become stiff or hurt in areas independent of the operative site. Patients may also benefit from engagement with hand therapy in order to provide them with strategies to accelerate their recovery.”
Michelotti, associate professor of surgery at the UW School of Medicine and Public Health and of plastic and reconstructive surgery and hand surgery at UW Health, and colleagues retrospectively collected preoperative carpal tunnel symptoms, diagnostic tests, medications and whether patients had concomitant OA among a cohort who underwent carpal tunnel release between Jan. 1, 2018, and Nov. 1, 2021. Researchers stratified patients into groups based on whether they had arthritis (n = 61; 86 hands) or not (n = 147; 226 hands). Patients with arthritis were further stratified based on whether they had carpometacarpal arthritis (64 hands), wrist arthritis (15 hands) or hand arthritis (40 hands).
Researchers considered health care utilization as measured by duration and frequency of hand clinic and occupational therapy follow-up after carpal tunnel release as the primary outcome of the study. Researchers also recorded postoperative complications, including the timing and type of complication, and need for revision surgery for recurrent or persistent symptoms.
Results showed patients without arthritis had an average duration of surgeon follow-up of 25.3 days compared with 87.1 days for patients with any arthritis. This duration was 172 days for patients with wrist arthritis.
Patients with hand arthritis had an increased average number of postoperative surgeon visits, with an average of 2.3 visits vs. 1.34 visits for patients without arthritis, according to researchers. However, the number of occupational therapy visits and duration of occupational therapy follow-up did not differ between the groups.
Persistent carpal tunnel syndrome symptoms were the only complication across cohorts, with 9.18% of patients without arthritis experiencing persistent symptoms vs. 13.9% of patients with arthritis.
For more information:
Brett F. Michelotti, MD, can be reached at 600 Highland Ave., Madison, WI 53792; email: michelotti@surgery.wisc.edu.
Perspective
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Asif M. Ilyas, MD, MBA, FACS, FAAOS
Robert E. George, MD, and colleagues examined the effect of thumb, hand and wrist osteoarthritis on postoperative clinic and therapy visits after carpal tunnel release surgery. This surgery is among the most common surgeries performed annually and enjoys a high success rate.
Although there are many variables that can potentially result in increased postoperative visits following carpal tunnel release surgery, indeed the presence of OA is recognized as a potentially exacerbating diagnosis. Now identified by George and colleagues, the pathogenesis is assumed to be the postoperative swelling following carpal tunnel release surgery potentially aggravating preexisting arthritis and/or the induction of a generalized systemic inflammation response resulting in arthritic joint synovitis, as well as adjacent tenosynovitis. The findings by George and colleagues are useful for surgeons advising patients indicated for carpal tunnel release surgery with preexisting arthritis to be prepared for a potentially longer postoperative recovery time. These study findings may also indicate the use for NSAIDs to be prescribed postoperatively for patients with preexisting arthritis.
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