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Management of Carpal Tunnel Syndrome by Members of the American Association for Hand Surgery
Eon K. Shin, MD; Abdo Bachoura, MD; Sidney M. Jacoby, MD; Neal C. Chen, MD; A. Lee Osterman;
Thomas Jefferson University Hospital


Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting the upper extremity, yet evidence-based guidelines for its diagnosis and treatment are lacking. Numerous factors such as the surgeon's academic background, residency training, and clinical experience may affect the decision-making for the evaluation and treatment of patients with carpal tunnel syndrome. In this survey-based study, we set out to expose any potential discrepancies in CTS practice attitudes based on these and other factors.


This was an online survey-based study. Active members, candidate members, and international members of the American Association for Hand Surgery (AAHS) were sent an electronic mail request (n=817) by the AAHS administration on behalf of the authors. This online questionnaire consisted of 12 questions that queried surgeons' approaches to the diagnosis as well as operative and non-operative management of carpal tunnel syndrome.


One hundred twenty-three surgeons responded to the survey, yielding a response rate of 15.1%. The locations of surgical practices varied within the United States and beyond. Most respondents were either orthopaedic or plastic surgeons in a nearly equal distribution. With respect to practice duration, 15.4% had been in practice for 5 years or less, 30.9% of the respondents had been in practice between 6-15 years, 30.9% had been in practice between 16-25 years, and 26.8% had been in practice for more than 25 years. The most notable interspecialty differences were related to the use of operative antibiotics and the surgical approach (Figures 1-2). Plastic surgeons were less likely to recommend antibiotic use during surgery and more likely to utilize an open extensile approach during surgical release. Younger surgeons were more likely to employ a mini-open approach for carpal tunnel release (Figures 3).


Practice attitudes towards CTS continue to change and evolve over time. Based on the results of this survey, we conclude that background training and generational differences contribute to the varied approaches observed in the diagnosis and management of CTS.

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