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National Trends in the Diagnosis of CRPS after Open and Endoscopic Carpal Tunnel ReleaseFunding None.
18 April 2018
07 January 2019
27 February 2019 (online)
Background Complex regional pain syndrome (CRPS) occurs in 2 to 8% of patients that receive open or endoscopic carpal tunnel release (CTR). Because CRPS is difficult to treat after onset, identifying risk factors can inform prevention. We determined the incidence of CRPS following open and endoscopic CTR using a national claims database. We also examined whether psychosocial conditions were associated with CRPS after CTR.
Methods We accessed insurance claims using diagnostic and procedural codes. We calculated the incidence of CRPS following open carpal tunnel release and endoscopic carpal tunnel release within 1 year. The response variable was the presence of CRPS after CTR. Explanatory variables included procedure type, age, gender, and preoperative diagnosis of anxiety or depression.
Results The number of open CTRs (85% of total) outweighs the number of endoscopic procedures. In younger patients, the percentage of endoscopic CTRs is increasing. Rates of CRPS are nearly identical between surgery types for both privately insured (0.3%) and Medicare patients (0.1%). Middle aged (range: 40–64 years) and female patients had significantly higher rates of CRPS than did the general population. Preoperative psychosocial conditions did not correlate with the presence of CRPS in surgical patients.
Clinical Relevance The decision between endoscopic and open CTR should not be made out of concern for development of CRPS postsurgery, as rates are low and similar for both procedures. Rates of CRPS found in this study are much lower than rates found in previous studies, indicating inconsistency in diagnosis and reporting or generalizability of prior work. Preoperative psychosocial disorders and CRPS are unrelated.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.
- 1 Birklein F, O'Neill D, Schlereth T. Complex regional pain syndrome: an optimistic perspective. Neurology 2015; 84 (01) 89-96
- 2 Jänig W, Baron R. Complex regional pain syndrome is a disease of the central nervous system. Clin Auton Res 2002; 12 (03) 150-164
- 3 Maihöfner C. [Complex regional pain syndrome: a current review]. Schmerz 2014; 28 (03) 319-336
- 4 Bruehl S. Complex regional pain syndrome. BMJ 2015; 351: h2730
- 5 Li Z, Smith BP, Smith TL, Koman LA. Diagnosis and management of complex regional pain syndrome complicating upper extremity recovery. J Hand Ther 2005; 18 (02) 270-276
- 6 Li Z, Smith BP, Tuohy C, Smith TL, Andrew Koman L. Complex regional pain syndrome after hand surgery. Hand Clin 2010; 26 (02) 281-289
- 7 Roh YH, Lee BK, Noh JH. , et al. Factors associated with complex regional pain syndrome type I in patients with surgically treated distal radius fracture. Arch Orthop Trauma Surg 2014; 134 (12) 1775-1781
- 8 Zollinger PE, Kreis RW, van der Meulen HG, van der Elst M, Breederveld RS, Tuinebreijer WE. No higher risk of CRPS after external fixation of distal radial fractures - subgroup analysis under randomised vitamin C prophylaxis. Open Orthop J 2010; 4: 71-75
- 9 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (05) 491-497
- 10 Fajardo M, Kim SH, Szabo RM. Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am 2012; 37 (08) 1599-1605
- 11 Buller M, Schulz S, Kasdan M, Wilhelmi BJ. The incidence of complex regional pain syndrome in simultaneous surgical treatment of carpal tunnel syndrome and dupuytren contracture. Hand (N Y) 2017; 13 (04) 391-394
- 12 da Costa VV, de Oliveira SB, Fernandes MdoC, Saraiva RÂ. Incidence of regional pain syndrome after carpal tunnel release. Is there a correlation with the anesthetic technique?. Rev Bras Anestesiol 2011; 61 (04) 425-433
- 13 Chen L, Duan X, Huang X, Lv J, Peng K, Xiang Z. Effectiveness and safety of endoscopic versus open carpal tunnel decompression. Arch Orthop Trauma Surg 2014; 134 (04) 585-593
- 14 Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res 2015; 473 (03) 1120-1132
- 15 Kohanzadeh S, Herrera FA, Dobke M. Outcomes of open and endoscopic carpal tunnel release: a meta-analysis. Hand (N Y) 2012; 7 (03) 247-251
- 16 Barad MJ, Ueno T, Younger J, Chatterjee N, Mackey S. Complex regional pain syndrome is associated with structural abnormalities in pain-related regions of the human brain. J Pain 2014; 15 (02) 197-203
- 17 Lee D-H, Lee K-J, Cho KIK. , et al. Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome. J Pain 2015; 16 (06) 580-586
- 18 Pons T, Shipton EA, Williman J, Mulder RT. Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review. Anesthesiol Res Pract 2015; 2015: 956539
- 19 Rewhorn MJ, Leung AH, Gillespie A, Moir JS, Miller R. Incidence of complex regional pain syndrome after foot and ankle surgery. J Foot Ankle Surg 2014; 53 (03) 256-258
- 20 Harris EJ, Schimka KE, Carlson RM. Complex regional pain syndrome of the pediatric lower extremity: a retrospective review. J Am Podiatr Med Assoc 2012; 102 (02) 99-104
- 21 Harris J, Fallat L, Schwartz S. Characteristic trends of lower-extremity complex regional pain syndrome. J Foot Ankle Surg 2004; 43 (05) 296-301
- 22 de Mos M, de Bruijn AGJ, Huygen FJPM, Dieleman JP, Stricker BHC, Sturkenboom MCJM. The incidence of complex regional pain syndrome: a population-based study. Pain 2007; 129 (1-2): 12-20
- 23 Cagle Jr. PJ, Reams M, Agel J, Bohn D. An outcomes protocol for carpal tunnel release: a comparison of outcomes in patients with and without medical comorbidities. J Hand Surg Am 2014; 39 (11) 2175-2180
- 24 Thomsen NOB, Cederlund RI, Andersson GS, Rosén I, Björk J, Dahlin LB. Carpal tunnel release in patients with diabetes: a 5-year follow-up with matched controls. J Hand Surg Am 2014; 39 (04) 713-720
- 25 Pugely AJ, Martin CT, Harwood J, Ong KL, Bozic KJ, Callaghan JJ. Database and registry research in orthopaedic surgery: part i: claims-based data. J Bone Joint Surg Am 2015; 97 (15) 1278-1287
- 26 Field J, Warwick D, Bannister GC. Features of algodystrophy ten years after Colles' fracture. J Hand Surg [Br] 1992; 17 (03) 318-320
- 27 Zhang S, Vora M, Harris AHS, Baker L, Curtin C, Kamal RN. Cost-minimization analysis of open and endoscopic carpal tunnel release. J Bone Joint Surg Am 2016; 98 (23) 1970-1977
- 28 Demir SE, Ozaras N, Karamehmetoğlu SS, Karacan I, Aytekin E. Risk factors for complex regional pain syndrome in patients with traumatic extremity injury. Ulus Travma Acil Cerrahi Derg 2010; 16 (02) 144-148
- 29 Bailey R, Kaskutas V, Fox I, Baum CM, Mackinnon SE. Effect of upper extremity nerve damage on activity participation, pain, depression, and quality of life. J Hand Surg Am 2009; 34 (09) 1682-1688