Pain in the wrist, tingling and numbness, and in severe cases, thumb weakness are all symptoms of carpal tunnel syndrome, the most common nerve problem. Caused by compression of the median nerve within the carpal tunnel at the level of the wrist, the condition affects between 5 -10% of the population.
Most patients require surgery to decompress the carpal tunnel and retain hand function, but until now data on safety and effectiveness of the operation remained scarce.
Jennifer Lane, Versus Arthritis Clinical Research Fellow in Trauma and Orthopaedic Surgery explained: "Earlier studies may have overestimated the levels of major or minor complications seen in patients following decompression treatment leaving patients with mixed messages. Our aim was to identify the true scale of either reoperation or serious complications within patient groups, and also to improve the advice available for those patients at greater risk."
The team did a nationwide cohort analysis of all carpal tunnel decompression surgeries in patients aged 18 years or older, performed in the National Health Service in England between April 1, 1998, and March 31, 2017. 855 832 records were examined, making the study what is thought to be the largest national study on carpal tunnel decompression to date.
They were looking for the incidence of reoperation within 30 days and 90 days after surgery, or of serious postoperative complications such as nerve, vascular or tendon injury. Minor complications including pain, infection or scar disorders that did not require further admission to hospital or surgery were also measured.
Overall rates of reoperation or serious complications were very low. The 90-day local serious complication rate was 0·082%, and only 3.4% of cases went on to need a reoperation.
Looking further into demographic groups, excess risk of reoperation was associated with males in the older age bracket (>80 years) and those with greater levels of comorbidities, and socioeconomic deprivation. By contrast, local serious complications in the first 90 days after surgery were more likely in men and younger patients aged 18–29 years but without comorbidities.
"From the available evidence we have found that Carpal tunnel decompression surgery, as practiced in the National Health Service in England, appears to be safe," said Jenny. "This should help clinicians in their understanding of the role of decompression surgery within the treatment of carpal tunnel syndrome, and guide personalised shared decision making."
The study was funded by Versus Arthritis; Medical Research Council; Royal College of Surgeons of England and National Joint Registry research fellowship; University of Oxford; National Institute for Health Research; and National Institute for Health Research Biomedical Research Centre, Oxford.