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How Are We Treating Carpal Tunnel Syndrome? A 12-year Epidemiological Study
Jacques Henri Hacquebord, MD1; Brandon S Shulman, MD2; Lorraine Hutzler, BA2, John T. Capo, MD3; Siddharth Mahure, MD2
1University of California Irvine, Orange, CA, 2New York University Hospital for Joint Diseases, New York, NY

Background: Although operative treatment has long been accepted as the definitive management for Carpal tunnel syndrome (CTS), the current rate of surgical treatments remain poorly defined. Furthermore, surgical techniques remain heavily debated, with both endoscopic and open methods commonly performed. Using the New York Statewide Planning and Research Cooperative System (SPARCS), a comprehensive database that includes every patient surgically treated for CTS in New York State each year, we hypothesize that surgical treatment of CTS has increased at a rate greater than population increase and endoscopic carpal tunnel release (CTR) has increased in proportion compared to open CTR.
Methods:We used the SPARCS database to identify every open or endoscopic CTR performed in New York State from 2003 2014 (78,132 cases). We then stratified this data by year performed, type of surgery (open versus endoscopic), age, and gender. The number of open and endoscopic CTR per 100,000 New York State residents for each year was calculated to analyze the rate of change while controlling for total population change. Statistical analyses were performed to determine the demographic factors most common in patients requiring CTR.
Results: From 2003 2014, there was a 99% increase in open CTR and a 356% increase in endoscopic CTR when controlling for population increase. The 50-64 year old age group underwent the most surgery (41% of all CTRs), followed by the 25-49 year old age group (24% of CTRs), p=<0.01. All age groups saw an increase in the percentage of endoscopic releases over time. Women accounted for 66% of all cases (p=<0.01) but gender did not significantly influence the surgical technique used.

Discussion: The rate of surgical treatment for CTS has significantly increased, even when controlling for total population growth. The rate of endoscopic CTR has increased at a far greater rate than open CTR and accounts for the majority of all CTR cases since 2011. This reflects a nationwide trend toward a greater proportion of endoscopic procedures. This study is one of the largest and most current epidemiological investigations into the treatment of CTS to date, and can be used to better understand the resource distribution and current surgical care for CTS. Finally, while the current study does not address causation, the nearly three-fold increase in total CTR over a 12-year period is an alarming rise and requires further investigation.


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