• Nancy A Baker and Heather M Livengood.
• Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA.
• J Hand Surg Am. 2014 Sep 1; 39 (9): 1792-8.

PurposeTo study the relationship between the severity of carpal tunnel syndrome (CTS) symptoms and surgery for CTS and the relationship between conservative treatments and surgery for CTS.MethodsA secondary analysis of baseline to 6-month data from a randomized controlled trial, which examined the effectiveness of orthosis/stretch combinations on the symptoms of CTS, was conducted for a total of 96 participants with CTS. Participants completed the Carpal Tunnel Questionnaire and posttreatment surveys. Statistical analyses included exploration of correlates of progression to surgery for CTS and logistical regression to examine the association between conservative treatments and CTS symptoms and progression to surgery for CTS.ResultsTwenty-one participants received surgery for their CTS, and 31 participants received 1 or more conservative treatments. Severity of baseline CTS symptoms and additional treatments were indicators of progression to surgery. The randomized controlled trial intervention was inversely associated with progression to surgery.ConclusionsCTS that does not respond to an initial course of conservative treatment may not improve with additional treatments. More than half of the participants who received additional conservative treatment still progressed to surgery. Current intervention guidelines for CTS provide limited guidance as to the best methods to efficiently treat CTS.Clinical RelevanceCTS is a costly and high-burden disorder, resulting in reduced quality of life. Research should examine when and for whom conservative care is an effective choice and the association between conservative care and the eventual need for CTS surgery.Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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