MAINE CARPAL-TUNNEL STUDY - OUTCOMES OF OPERATIVE AND NONOPERATIVE THERAPY FOR CARPAL-TUNNEL SYNDROME IN A COMMUNITY-BASED COHORT

A prospective, community-based, observational study of the outcome of surgical and nonoperative management was conducted. The study included 429 patients with carpal tunnel syndrome recruited in physicians' off ices throughout Maine. Patients were assessed at baseline and at 6, 18 , and 30 months following presentation using validated scales that mea sured symptom severity, functional status, and satisfaction. Seventy-s even percent of eligible survivors from the original cohort were monit ored for 30 months. Surgically treated patients demonstrated improveme nts of 1.2 to 1.6 points on the 5-point Symptom Severity and Functiona l Status scales (23% to 45% improvement in scores), which persisted ov er the 30-month follow-up period. The nonoperatively managed patients showed little change in clinical status at 6, 18, and 30 months. While workers' compensation recipients had worse outcomes than nonrecipient s, 36 of 68 (53%) workers' compensation recipients were completely or very satisfied with the results of the procedure 30 months after surge ry. There were no significant differences in outcome between patients treated with endoscopic versus open carpal tunnel release. Among worke r's compensation recipients, 12 of 68 (18%) surgical patients and 4 of 32 (13%) nonoperatively treated patients remained out of work because of carpal tunnel syndrome at 30 months. Thus, carpal tunnel surgery o ffered excellent symptom relief and functional improvement in this pro spective community-based sample, irrespective of the surgical approach , even in workers' compensation recipients. Work absence remained high in both surgically and nonoperatively managed workers' compensation r ecipients. (J Hand Surg 1998;23A:697-710. Copyright (C) 1998 by the Am erican Society for Surgery of the Hand.)