Factors Affecting Return to Work After Carpal Tunnel Syndrome Surgery in a Large French Cohort

Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, France.
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 11/2011; 92(11):1863-9. DOI: 10.1016/j.apmr.2011.06.001
Source: PubMed


To evaluate occupational outcomes after surgical release of the median nerve in carpal tunnel syndrome (CTS).
Retrospective study 12 to 24 months after surgery.
Hand centers (N=3) in 2 different areas.
Patients who had undergone surgical release of the median nerve in 2002 to 2003.
Not applicable.
Duration of sick leave after surgery and associated factors were analyzed by using bivariate (log rank) and multivariate analyses of survival (Cox model).
Questionnaires mailed in 2004 regarding medical condition (history and surgery), employment (occupational category codes in 1 digit), and compensation were returned (N=1248; 62%), with 253 men and 682 women stating they were employed at the time of surgery (N=935). Most were working at the time of the study (n=851; 91.0%). Median duration of sick leave before returning to work was 60 days. The main factors associated with adverse occupational outcome (long duration of sick leave) were simultaneous intervention for another upper-extremity musculoskeletal disorder, belief (by the patient) in an occupational cause, and "blue-collar worker" occupational category (the strongest determinant).
This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients.

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    • "Study Number of subjects Number of hands Diagnosis Carpal tunnel release surgical procedure Post-operative advice Type of employment and return to work time (mean (±SD) unless otherwise stated) Phased >3 weeks: 6 weeks Parot- Schinkel (2011) [56] 935 Not specified Not specified Limited incision, Open release Not specified Probability of return to work by 30 days (95% CI) Farmers: 51.6 (35.6 e69.8) Self-employed: 64.3 (47.0e81.1) "
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    ABSTRACT: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes ‘nuisance’ symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed.
    Bailli&egrave re s Best Practice and Research in Clinical Rheumatology 05/2015; DOI:10.1016/j.berh.2015.04.026 · 2.60 Impact Factor
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    • "These findings are of relevance when a surgeon is attempting to predict a patient’s loss of working days and the accompanying economical and social implication [7]. There are numerous factors that have been shown to determine return to work time including psychological issues, job type and work-place features [1,4,5,8,9]. "
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    ABSTRACT: Background The assessment of post-surgical outcomes among patients with Workers’ Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients’ time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients. Findings Two authors independently searched MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for Workers’ Compensation patients versus their non-compensated counterparts. We assessed the studies’ quality using the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to work was longer for patients that were compensated and that there was a strong association between this outcome and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p < 0.001). Conclusions This study demonstrated that compensated patients have a longer return to work time following carpal tunnel release and elective rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving compensation for their condition. Type of study/level of evidence Meta-analysis of prospective Studies/ Level III
    Patient Safety in Surgery 01/2013; 7(1):1. DOI:10.1186/1754-9493-7-1
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    ABSTRACT: Objectives To study the employment and occupational outcomes of workers who were diagnosed with upper limb musculoskeletal disorders (UL-MSDs) or had complained of upper limb musculoskeletal pain a few years before compared with workers who had no upper limb pain. Methods In 2002–2005, an epidemiological surveillance system was set up. Occupational physicians examined 3710 randomly selected workers. It focused on six UL-MSDs: rotator cuff syndrome, lateral epicondylitis, flexor-extensor peritendinitis of the hands and fingers, de Quervain's disease, carpal tunnel syndrome and ulnar tunnel syndrome. Three groups were constituted: a ‘UL-MSD’ group (workers with a clinically diagnosed UL-MSD at baseline, 13% of the cohort); a ‘PAIN’ group (workers with pain in the previous 7 days at baseline and without any clinically diagnosed form, 38%); and a ‘HEALTHY’ group (workers with no disorder or upper limb pain in the previous 7 days, 49%). They completed a questionnaire between 2007 and 2009. Results A total of 2332 responded. Fewer subjects were still in work in the ‘UL-MSD’ group (79.3%) than in the ‘PAIN’ (85.9%) and ‘HEALTHY’ (90.4%) groups, the difference remaining significant after adjusting for gender, age, occupational category, type of company and comorbidities. Of the subjects still in work, 24% had changed their work station in the same company in the ‘PAIN’ group compared with 19% in the ‘HEALTHY’ group and 21% in the ‘UL-MSD’ group. Conclusions This study showed the impact of musculoskeletal pain on employment outcome and the difficulty of keeping workers with musculoskeletal problems at work.
    Occupational and Environmental Medicine 02/2012; 70(3):143-148. DOI:10.1136/oemed-2012-100685 · 3.27 Impact Factor
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