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J Wrist Surg 2019; 08(03): 209-214
DOI: 10.1055/s-0039-1678674
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

National Trends in the Diagnosis of CRPS after Open and Endoscopic Carpal Tunnel Release

Kevin Mertz
1   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
Jeremy Trunzter
1   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
Edward Wu
1   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
James Barnes
2   VA Palo Alto Health Care System, Center for Health Policy/Primary Care Outcomes Research, Stanford University, Palo Alto, California
,
Sara L. Eppler
1   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
Robin N. Kamal
1   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
› Author Affiliations
Funding None.
Further Information

Publication History

18 April 2018

07 January 2019

Publication Date:
27 February 2019 (online)

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Abstract

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.

Keywords

carpal tunnel release - carpal tunnel syndrome - complex regional pain syndrome - quality

Ethical Approval

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.[11] Informed consent was obtained from all patients for being included in the study.