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Comparison of Outcomes After Open Carpal Tunnel Release in Wheelchair Users Versus Non-Users
Eduardo Gutierrez, B.S.
1, Emmi N Deckard, B.S.
1, Jade Dai, B.A.
1, John P Mickley, M.D.
2; Keith T Aziz, M.D.
3(1)University of California, Riverside, School of Medicine, Riverside, CA, (2)UF Health - Jacksonville, Jacksonville, FL, (3)Mayo Clinic Florida, Jacksonville, FL
Introduction: Patients who use wheelchairs place increased functional demand on their upper extremities and previous studies suggest these patients have an increased risk of developing carpal tunnel syndrome (CTS). There is a lack of literature examining how wheelchair use impacts postoperative outcomes after open carpal tunnel release (OCTR). The purpose of this study is to examine outcomes after OCTR in wheelchair users versus patients who do not use wheelchairs (non-users), and evaluate whether there are differences in postoperative outcomes between these patient populations.
Materials & Methods: The TriNetX US collaborative database was queried to identify wheelchair users diagnosed with CTS who subsequently underwent OCTR between 2005-2025. This process was repeated to identify non-users diagnosed with CTS then treated with OCTR. Multivariate analysis was used to analyze and compare outcomes before and after 1:1 propensity score matching (PSM) to account for potential confounding variables.
Results: 476 Wheelchair users were identified and 205,737 non-users were identified who underwent OCTR. Before 1:1 PSM, wheelchair users experienced significantly higher occurrences at 90 days of wound dehiscence, postoperative infection, emergency room (ER) visits, non-opioid prescriptions and opioid prescriptions compared to non-users (Table 1). After 1:1 PSM, each cohort contained 475 patients and wheelchair users continued to exhibit significantly higher occurrences of ER visits, non-opioid prescriptions and opioid prescriptions at 90 days (Table 2). There was no significant difference at 90 days for undergoing a revision procedure in either analysis (Tables 1 and 2).
Conclusions: Within 90 days after OCTR, patients who use wheelchairs had increased occurrences of ER visits, non-opioid prescriptions and opioid prescriptions when compared to non-users. These findings provide insights for hand surgeons to consider when offering OCTR to wheelchair users with CTS. Future research should continue to explore the postoperative course in patients relying on their upper extremities for mobility and whether minimally invasive procedures such as endoscopic or ultrasound-guided techniques would reduce the occurrence of these outcomes within this unique population.
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