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PURPOSE: In 1987 Duncan et al. reported on a survey of the members of the American Society for the Surgery of the Hand (ASSH) about their practices in treating carpal tunnel syndrome. To better understand the current changes in the treatment of carpal tunnel syndrome over the past 25 years, we have repeated the survey while incorporating present day controversies.

METHODS: With the approval of the ASSH, an internet-based survey was emailed to all members of the ASSH. This included 30 sets of questions focusing on four areas of study: surgeon demographics, non-operative treatment, surgical technique, and post-operative care.

RESULTS: A total of 1463 surveys were delivered, 707 surveys were completed and returned for a total response rate of 48%. Responses were compared to the responses from Duncan et al. published 25 years ago. In contrast to the practice patterns identified 25 years ago, this survey identified several changes in current clinical practices including the following statistically significant findings: Pre-operatively, surgeons have increased the use of splints, use corticosteroid injections more often, treat non-operatively for a longer period of time, and have narrowed their surgical indications. Regarding surgical technique, surgeons now are utilizing tourniquets less, infiltrate the carpal tunnel with corticosteroids less, and place deep sutures less often. Furthermore, the practice of performing concomitant procedures other than release of the transverse carpal ligament has also decreased. Regarding post-operative care, splint use and length of use has decreased.

CONCLUSIONS: Compared to the treatment of carpal tunnel syndrome 25 years ago, hand surgeons participating in our survey now were found to institute more prolonged non-operative treatment, utilize narrower surgical indications, perform less concomitant surgical procedures, and apply post-operative splints less often.