HSS Study Reveals Why Men are More Likely to Be Offered Surgery for Carpal Tunnel Syndrome
Males presented with more severe carpal tunnel syndrome and were offered surgery more often than females with the condition, according to work by researchers at Hospital for Special Surgery (HSS) featured today in a poster presentation at the American Academy of Orthopaedic Surgeons 2022 Annual Meeting.
The study adds to a growing body of research by HSS investigators examining gender, racial/ethnic and socioeconomic disparities in diagnoses, treatment approaches and outcomes in a range of musculoskeletal conditions, including hip and knee replacement, lupus and rheumatoid arthritis.
“Our study aimed to investigate if disparities in treatment for carpal tunnel syndrome exist,” said Duretti Fufa, MD, HSS hand and upper extremity surgeon and senior author of the study. “Patients and surgeons should always be aware of potential biases when discussing and making treatment decisions, especially for patients with moderate disease symptoms where the decision to pursue surgery is more subjective.”
The carpal tunnel is the narrow space within the wrist that contains bones, tendons, ligaments and the median nerve responsible for transmitting sensations from the fingers and thumb. Compression of the median nerve from prolonged wrist flexion or extension, trauma, arthritis or inflammation of wrist tendons can cause numbness, weakness and tingling in the hand and arm, resulting in carpal tunnel syndrome.
Electrodiagnostic testing to confirm a diagnosis of carpal tunnel syndrome consists of nerve conduction studies that assess how electrical signals move through the median nerve to hand muscles and electromyography (EMG) testing that evaluates whether the muscles activate correctly in response to those signals. Test results indicate whether disease severity is mild, moderate or severe.
Patients with mild symptoms are typically offered nonsurgical treatments such as bracing or steroid injections. Patients with severe symptoms are often offered carpal tunnel release, a minimally invasive surgical procedure that relieves pressure on the median nerve by cutting the carpal ligament. “However, for patients with moderate symptoms, it’s not as obvious whether a nonsurgical or surgical approach is best,” said Dr. Fufa. “There is more decision-making involved, and therefore a higher potential for patient factors and potentially subconscious biases to influence recommendations for surgery.”
For the study, Dr. Fufa and colleagues reviewed hospital records for 949 patients with carpal tunnel syndrome treated at HSS between February 2016 and October 2020. All patients had been diagnosed by HSS hand surgeons and received electrodiagnostic testing. The researchers grouped patients’ records according to disease severity and looked for differences in treatment recommendations, completion of treatment and the time interval between being offered surgery by gender, race/ethnicity and age.
There were two interesting findings within the moderate disease severity group of 141 females and 90 males: Females were 23 percent less likely to be offered surgery than males, and Hispanic and Black females were four times less likely to be offered surgery than their male counterparts. These trends were strong but not statistically significant, given the size of the study.
“Overall, our findings suggest that increased utilization by males was largely explained by the fact that men were more likely to present with more severe carpal tunnel syndrome,” Dr. Fufa said. “I suspect that with larger numbers of patients to study, differences based on gender and race may prove to be significant. In the meantime, we hope our findings increase awareness of potential biases to ensure we are providing equitable care to all patients.”
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a second consecutive year (2022). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.