LETTER TO THE EDITOR

RE: Predictors of Return to Work After CarpalTunnel Release

KEYWORDS: carpal tunnel release; physical therapy; rehabilitation; return to work

We read with interest the report of Katz et al. [1997]regarding predictors of return to work following carpaltunnel release (CTR). We agree with the authors that avariety of psychosocial factors can potentially affect thereturn-to-work interval following CTR. The experience ofShor and Miller [1996] suggests that 25% of treatment is topathology of the condition and 75% revolves around bio-psychosocial interactions.

Katz et al. [1997] did not consider one such biopsycho-social interaction, which we consider important, in theirreturn-to-work predictions: the health care provider-patient relationship. Our experience with rehabilitation ofCTR patients is that almost all who are managed closelyfollowing CTR surgery can return to their usual occupationswithin several days to 2 weeks of surgery [Nathan et al.,1993].

Prior to surgery, we address the psychosocial aspects ofthe procedure, educating patients about the normal sequelaeof the surgical intervention. Specifically, we inform patientsthat carpal tunnel surgery is an uncomplicated procedure andthat discomfort experienced in the initial postoperativephase is a routine consequence of the procedure and notindicative of an unresolved problem or a disabling condi-tion.We set a specific time frame for release for work and weask patients to agree to participate actively in postoperativerehabilitation. A physical therapy rehabilitation programbegins the day after surgery and is used not only to promotehealing and mobilization of the extremity, but also toprovide psychological support and encouragement for the

resumption of the activities of daily living, particularlyreturn to work.

Based on a retrospective/prospective study of 216patients (293 releases) who underwent CTR during a 5-yearperiod [Nathan et al., 1993], we found that most returned totheir usual occupation after three to six physical therapysessions. Keyboard users continued to use keyboards, andmachine operators continued to operate machines. As in theKatz study, patients with workers’ compensation insurancetook significantly longer to return to work than patientscovered by private insurance. We found that this was due tononmedical factors. Our study also confirmed the finding ofKatz et al. [1997] that specific occupation made little or noindependent contribution to predicting the return-to-workinterval.

We recommend that further research on predictors ofpost CTR return-to-work time consider the role of healthcare providers in either facilitating or retarding the postopera-tive recovery process.

Peter A. Nathan,MDKenneth D. Meadows,PTRichard C. Keniston,MDPortland Hand Surgery and Rehabilitation CenterPortland, OR 97210-2997

REFERENCES

Katz JN, Keller RB, Fossel AH, Punnett L, Bessette L, Simmons BP,Mooney N (1997): Predictors of return to work following carpal tunnelrelease. Am J Indust Med 31:85–91.

Nathan PA, Meadows KD, Keniston RC (1993): Rehabilitation of carpaltunnel surgery patients using a short surgical incision and an early programof physical therapy. J Hand Surg 18A:1044–1050.

Shor MJ, Miller JC (1996): The role of managed care in work-relatedinjuries. Orthop Clin NA 27:711–721.

Correspondence to: Dr. Peter A. Nathan, Portland Hand Surgery and Rehabilita-tion Center, 2455 N. W. Marshall, Suite 1, Portland, OR 97210-2997

Received for publication 26 February 1997

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 32:321 (1997)

r 1997 Wiley-Liss, Inc.