Return to Activities After Simultaneous Bilateral Endoscopic Carpal Tunnel Release
Rachel E Hein, MD1, Amanda N Fletcher, M.D.1, Andrew W Hollins, M.D.1, David S Ruch, MD1, Marc J. Richard, MD1 and Suhail Kamrudin K. Mithani, MD2, (1)Duke University Medical Center, Durham, NC, (2)Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
Carpal tunnel syndrome (CTS) is present bilaterally in 56% of patients diagnosed. Few studies have investigated bilateral simultaneous Endoscopic Carpal Tunnel Release (ECTR) and postoperative effect on return to activity. The purpose of this study was to evaluate length of recovery in patients who received bilateral simultaneous ECTR including pain medication requirement, return to activities of daily living, return to work, and return to full activities.
Materials and Methods:
A retrospective analysis was performed on patients who underwent bilateral ECTR by a single hand fellowship trained surgeon from 2013-2019. All patients were counseled preoperatively and given written guidelines regarding minimal restrictions on activity after surgery. Occlusive incisional dressings were employed intraoperatively and patients were transitioned to a Band Aid dressing postoperative day two. Demographic, operative, clinical data, and subjective patient outcomes were collected via chart review and a telephone interview. Student's T-tests and Chi Squared analyses were conducted, and a probability of ≤0.05 was considered significant.
80 patients (160 wrists) were included in the study. The average patient age was 53 years-old (range 20-80) with 49 (61%) female patients. Of the 80 patients, 40 were successfully contacted for telephone interview follow-up. Questions included data regarding return to activities of daily living, work, and return to full activities as well as the amount of pain medication required. Patients reported to take an average of two days (range 0-10) of narcotic pain medications. Patients returned to activities of daily living, work, and recreational activities at an average of five, seven, and 19 days, respectively.
Female patients reported requiring more days of narcotic pain medications (1 versus 3 days, p=0.0483) and longer time to return to work (9 versus 5 days, p=0.0477). Manual laborers reported longer time to return to work (9 versus 5 days, p=0.0500). Older patients (age > 65) reported longer return to full activities (39 versus 11 days, p=0.0189).
Simultaneous bilateral ECTR is a successful procedure with shorter recovery times than reported previously for bilateral simultaneous and staged carpal tunnel release . Preoperative counseling and encouragement to return to full activity after surgery appears to be effective for this procedure. Several risk factors for increased pain medication requirement and longer time to return to work and full activity include females, manual laborers, and older age (>65).
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