• Jay Pomerance, David Zurakowski, and Ilene Fine.
• Harvard Medical School, Children's Hospital Boston, Department of Orthopedic Surgery, Boston, Massachusetts, USA. jpomerance@handsurgerydoc.com
• J Hand Surg Am. 2009 Sep 1; 34 (7): 1193-200.

PurposeTo compare direct costs and results for patients with electrodiagnostically proven carpal tunnel syndrome treated with surgery versus nonsurgical care.MethodsThere is a retrospective study of 120 patients divided into 2 groups: subjects in group 1 had chosen nonsurgical treatment, whereas subjects in group 2 had chosen surgery with no nonsurgical treatment. Patients were matched on age, gender, severity of nerve conduction abnormalities, body mass index, smoking history, job category, and insurance coverage. Direct cost of care was measured. An incremental cost-utility ratio was calculated to compare costs between the different management strategies.ResultsGroup 1 follow-up averaged 13 +/- 5 months compared to 12 +/- 2 months for group 2. Steroid injections were used in 18 patients in group 1. Thirty-two patients in group 1 elected to have surgery during the follow-up period. Cost of care averaged $3335 +/- $2097 in group 1 and $3068 +/- $983 in group 2.ConclusionsThe direct cost of nonsurgical care of confirmed carpal tunnel syndrome did not show a significant difference from that of surgical treatment without preoperative splinting or therapy. The incremental cost-utility ratio for carpal tunnel surgery was favorable. Surgery, rather than nonsurgical care, should be considered as the initial form of treatment when patients are diagnosed with carpal tunnel syndrome that is confirmed by nerve conduction studies, as this provides symptom resolution with a favorable cost analysis.Type Of Study/Level Of EvidenceEconomic and Decision Analysis III.

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