Return to work after carpal tunnel release surgery

Lead Investigator: Karen Walker-Bone
Co-Investigators:  Lisa Newington, Cathy Linaker, David Coggon, Clare Harris, Cyrus Cooper, Keith Palmer, David Warwick, Jo Adams
Funders: Arthritis Research UK and MRC

Background:
Carpal tunnel syndrome (CTS) is an important cause of upper limb disability. Conservative management may produce symptomatic relief in mild cases, but those with more severe disease are normally treated by surgery. Some 50,000 procedures for CTS are performed annually in the UK with a reported success rate of 70-90%.However, the time taken to return to work after surgery varies substantially, from as little as a mean of 4.3 days in one study to longer than three months in others. This variation could reflect differences in the advice that surgeons give their patients; it is unclear whether early return to work is detrimental to the outcomes of surgery or whether it is safe and appropriate.

Main study questions:
(1) What advice do surgeons and hand therapists currently give to their patients about return to work after carpal tunnel release (CTR) surgery? Do they vary their advice according to the type of operation or the type of work that the patient does?
(2) In the event that people return to work early after CTR surgery, do they experience more complications or symptoms?

Study design:
To answer question 1, we will survey all members of the British Society for Surgery of the Hand (BSSH) and all members of the British Association of Hand Therapists (BAHT) about their usual practice in relation to patients wishing to return to work after CTR surgery. We will design a questionnaire to explore whether surgeons/therapists ‘tailor’ their advice to individuals and if so, on what basis.
In a second phase, we will prospectively recruit 400 patients as they attend for their CTR surgery. We will obtain pre-operative information about symptoms, occupation and workplace exposures, and follow them up at 6 weeks and 3 months to establish the outcome of their surgery and when they return to work involving (a) modified and (b) normal duties. We will use the results to explore to what extent early return to work is associated with increased complications or symptoms. The findings will be used either to inform new guidance for patients and health professionals, or to design a randomised controlled trial to assess further the impact of specific advice on return to work.

Outputs:
Newington L, Francis K, Ntani G, Warwick D, Adams J, Walker-Bone K. Return to work recommendations after carpal tunnel release: A survey of UK hand surgeons and hand therapists. Journal of Hand Surgery: European Volume 2018;43(8):875-878 doi:10.1177/1753193418786375

Newington L, Warwick D, Adams J, Walker-Bone K. Variation in preoperative management of carpal tunnel syndrome (letter). RCS Bulletin 2018;100(5):199-200 doi:10.1.1308/rcsbull.2018.199

Newington L, Stevens M, Warwick D, Adams J, Walker-Bone K. Sickness absence after carpal tunnel release: a systematic review of the literature. Scand J Work Environ Health 2018;44(6):557-567 doi:10.5271/sjweh.3762

Newington L, Brooks C, Warwick D, Adams J, Walker-Bone K. Return to work after carpal tunnel release surgery: a qualitative interview study. BMC Musculoskeletal Disorders 2019;20:242