Thinking About Having Carpal Tunnel Surgery? Read How Others Made This DecisionThinking about having surgery for carpal tunnel syndrome? Need some help deciding? Making a decision about the best way to treat carpal tunnel syndrome isn't always easy. The results of this study help point out patient concerns and considerations when mulling over whether or not to have surgery.
Two groups of Korean women (all homemakers, none on Worker's compensation) with confirmed carpal tunnel syndrome of unknown cause were included in the study. Electrodiagnostic tests (e.g., nerve conduction velocity, electromyography) were used to make sure that the pain, numbness, and weakness (typical signs of carpal tunnel syndrome) were indeed caused by compression on the median nerve in the wrist. Those tests aren't always 100 per cent accurate (there are false positive or false-negative results) but research shows they are reliable for the majority of patients.
Recent studies have shown that patients with electrodiagnostically confirmed carpal tunnel syndrome are candidates for decompressive surgery. The surgeon releases pressure on the nerve by cutting through the band of connective tissue that crosses the wrist over the nerve. The tissue that is released is called the carpal ligament or retinaculum. Some patients may opt to try conservative (nonoperative) care first with antiinflammatory medications, steroid injections, and hand therapy. But failure to improve with nonoperative care is another indication that surgery might be warranted.
Today's patient is more of a health-care consumer. Surgeons advise and educate about the condition and treatment options, but patients make the final decision. In this study, consumer concerns and factors influencing treatment decisions were explored. Patients usually have a specific reason why they go ahead with the surgery or why they choose to avoid (even cancel a scheduled) operation. But surgeons don't always know what motivates patients to go ahead with surgery or cancel it all of a sudden. The results of this study might shed some light on that subject.
Everyone in the study had been given at least eight weeks of conservative care including antiinflammatories, steroid injections, and a rigid brace to hold the wrist in a neutral position (not bent or extended). Once the decision had been made to have surgery, there was a four-week waiting period. At the end of the month's time, 13 per cent of the women canceled the upcoming surgery. They said the number one reason for the cancellation was that their symptoms were better. Since none of these women were Worker's Comp patients, they said that their secondary concern about having the surgery was financial. They also mentioned some concern about having a scar across the wrist.
For those who went ahead with the scheduled operation, they were asked what was the main reason they pressed on and didn't cancel the surgery. They listed symptom severity as the number one reason for having the surgery. Everyone in both groups was worried about symptoms coming back but at the final follow-up results were equally good in both groups.
The authors also analyzed characteristics of women in both groups by age, marital status, symptom duration, income, and education. The groups were very similar in all ways, which lends to the validity of comparing one group to the other. If there were big differences in any of these factors, it might not be clear which factors really contributed to the decision-making process.
The results of this study show that concern about finances and appearance are more important factors in canceling carpal tunnel surgery than fear of having the operation. The cancellation group did express more concern about how the surgery would affect their ability to care for their family. Testing done before the scheduled surgery showed equal functional abilities between the groups, so these concerns on the part of the cancellation group were not necessarily based on worse function compared with the surgical group.
The authors conclude that this is the first study to attempt to understand patients' thinking about surgery for carpal tunnel syndrome. It appears that concerns and feelings are more influential than the objective electrodiagnostic test results when making the decision to have surgery for carpal tunnel syndrome -- at least in this particular group of women. Further studies repeating this analysis with other potential carpal tunnel surgical patients may help confirm these results. Different age groups of varied ethnicity/racial background may have other ways of looking at this decision.
It's entirely possible that patterns of surgery avoidance vary depending on the underlying problem. In the case of carpal tunnel syndrome, the condition is not life-threatening and not even likely to cause permanent paralysis. Some women may decide to avoid surgery and see what happens over time. This study only included patients who were initially signed up for surgery. It didn't include women who never considered surgery as a possible treatment option and what they might say about their concerns.
Hyun Sik Gong, MD, PhD, et al. Factors Affecting Willingness to Undergo Carpal Tunnel Release. In The Journal of Bone & Joint Surgery. September 2009. Vol. 91A. No. 9. Pp. 2130-2136.
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