What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance.
Nancy A Baker, Joel M Stevans, Lauren Terhorst and 3 others
PMID 29452295WHAT IT FOUND
Most commercially insured patients with carpal tunnel syndrome received no documented treatment or only one visit.
Splinting was the most common early conservative care. Surgery occurred in 24% of patients, typically after initial conservative management. Actual practice largely matched guideline recommendations.
Key findings
01Over half of patients received no reported treatments during the 36-month follow-up period.
02Surgery was the most frequently reported treatment type overall, occurring in 24% of patients, with positioning (splinting) second at 20.7%.
03Patients seeing an orthopedist as their first provider were significantly more likely to receive treatments and return for visits than those seeing general practitioners.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relied on insurance claims data, so the accuracy of the carpal tunnel diagnosis and the severity of symptoms could not be verified. Over-the-counter splints purchased by patients were not captured in the claims, meaning the use of positioning treatments is likely underreported. The study did not include patients with workers' compensation insurance, who may have different treatment pathways and outcomes. The analysis could not determine whether second surgeries were revisions of failed procedures or bilateral releases. The study did not measure clinical outcomes or patient satisfaction, only treatment patterns and visit frequency.
Declared interests
The authors declared no conflicts of interest. The study was supported by a grant from the National Institutes of Health.
The easy way to misread this
Do not conclude that physical therapy and occupational therapy are ineffective or rarely indicated based on their low appearance in the claims data. The study explicitly notes that many conservative treatments were underreported, and splinting purchased over-the-counter was not captured, meaning the actual frequency of non-surgical care is likely higher than the data show.