CARPAL-TUNNEL SYNDROME IN PRIMARY-CARE - A REPORT FROM ASPN

Background. Carpal tunnel syndrome (CTS) is a common condition in prim ary care, yet little is known about its presentation and management. T his study was designed to provide a better understanding of the freque ncy of CTS in a primary care population, and its presentation, diagnos is, and management. Methods. Clinicians in 74 Ambulatory Sentinel Prac tice Network (ASPN) practices from 30 states and three Canadian provin ces collected data on all patients presenting with symptoms of CTS dur ing a 30-month period. Results. The adjusted frequencies of all visits and of first visits for symptoms of CTS were 1.01 and 0.68 per 1000 p atient visits, respectively. Women visited more frequently than men wi th new onset symptoms of CTS (0.81 vs 0.55 per 1000 visits), and homem akers accounted for 15.9% of all new cases. Clinicians judged 43.1% of all CTS incident visits to be job-related. The diagnostic evaluation of patients seldom ineluded nerve conduction studies (12.9%) or electr omyography (11.8%). The most frequent treatments were splints (56.3%) and nonsteroidal anti-inflammatory agents (50.8%). Four-month follow-u p data were obtained for 68.5% of the patients, and symptom relief was reported by 55.2% of patients. Ninety percent of patients were able t o continue working at the same job, and 96% were able to continue thei r usual activities. Conclusions. Carpal tunnel syndrome symptoms are c ommon in primary care, and most cases occur among women, many of whom are homemakers. Most patients with CTS symptoms are treated conservati vely by their primary care clinicians with minimal testing or referral , and most patients report improvement or resolution of symptoms at 4 months.