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Work‐related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost work
Author(s) -
Daniell William E.,
FultonKehoe Deborah,
Franklin Gary M.
Publication year - 2009
Publication title -
american journal of industrial medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.7
H-Index - 104
eISSN - 1097-0274
pISSN - 0271-3586
DOI - 10.1002/ajim.20765
Subject(s) - medicine , workers' compensation , carpal tunnel syndrome , work (physics) , surgery , duration (music) , compensation (psychology) , occupational safety and health , occupational medicine , occupational exposure , physical therapy , emergency medicine , pathology , psychology , psychoanalysis , mechanical engineering , art , literature , engineering
Background Work‐related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability. Methods This population‐based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n = 8,224) filed during 1990–1994 (followed through 2000) and receiving lost‐work compensation. Results Sixty‐four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P < 0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non‐CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery. Conclusions There is a need to scrutinize the role of surgery and physical‐rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post‐operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution. Am. J. Ind. Med. 52:931–942, 2009. © 2009 Wiley‐Liss, Inc.