Dunn John C, Kusnezov Nicholas A, Koehler Logan R, Vanden Berge Dennis, Genco Ben, Mitchell Justin, Orr Justin D, Pallis Mark
1 William Beaumont Army Medical Center, El Paso, TX, USA.
2 Texas Tech University Health Sciences Center El Paso, USA.
Hand (N Y). 2018 Mar;13(2):137-142. doi: 10.1177/1558944717701240. Epub 2017 Apr 7.
Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers' compensation (WC) claims.
The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria. A systematic review was generated; patient demographics, outcomes, and complications were recorded. Weighted averages were calculated for the demographic and outcome data. Categorical data such as complications were pooled from the studies and used to determine the overall complication rate. Statistical significance was determined between WC and non-WC cohorts when applicable with the chi-square statistic.
The WC cohort included 1586 wrists, and the non-WC cohort included 2781 wrists. The WC cohort was younger and more often involved the dominant extremity. The WC cohort was less likely to have appropriate physical exam findings confirming diagnosis and electrodiagnostic studies. WC patients took almost 5 weeks longer to return to work, were 16% less likely to return to preinjury vocation, and had lower Standard Form (SF)-36 scores. Finally, WC patients had nearly 3 times the number of complications and nearly twice the rate of persistent pain.
WC patients undergoing carpal tunnel release (CTR) fare poorly as compared with non-WC patients in nearly every metric. Higher rates of postoperative pain with delayed return to work can be anticipated in a WC cohort. In addition, WC patients receive suboptimal preoperative workup, and it is possible that unnecessary surgery is being completed in these cases. These findings are important to consider when treating the WC patient with CTS.
腕管综合征（CTS）是一种常见的职业性疾病，在工伤赔偿（WC）索赔中占比很高。
回顾了1993年至2016年间所有评估CTS治疗结果（包括WC患者）的研究文献。共识别出348篇文章；其中25篇符合纳入和排除标准。进行了系统综述；记录了患者的人口统计学数据、治疗结果和并发症。计算了人口统计学和治疗结果数据的加权平均值。从研究中汇总并发症等分类数据，用于确定总体并发症发生率。适当时，采用卡方统计量确定WC队列和非WC队列之间的统计学显著性。
WC队列包括1586只手腕，非WC队列包括2781只手腕。WC队列患者更年轻，且更常累及优势肢体。WC队列患者通过适当的体格检查结果确诊和进行电诊断研究的可能性较小。WC患者返回工作岗位的时间几乎要长5周，回到受伤前职业的可能性要低16%，且标准量表（SF）-36评分更低。最后，WC患者的并发症数量几乎是非WC患者的3倍，持续疼痛发生率几乎是非WC患者的2倍。
与非WC患者相比，接受腕管松解术（CTR）的WC患者在几乎所有指标上的治疗效果都较差。预计WC队列患者术后疼痛发生率更高，返回工作岗位的时间会延迟。此外，WC患者术前检查不充分，在这些病例中可能进行了不必要的手术。在治疗患有CTS的WC患者时，这些发现很重要，值得考虑。
