Newsroom Hospital for Special Surgery

HSS Study Reveals Why Men are More Likely to Be Offered Surgery for Carpal Tunnel Syndrome

Tue, 22 Mar 2022 12:00:00 -0400

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 Presents New Research at the AAOS 2022 Annual Meeting

Tue, 22 Mar 2022 10:00:00 -0400

At this year’s American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, HSS physicians and scientists presented exciting new research related to clinical advancements for care and patient outcomes in orthopedics.

Highlights include gender and health disparities research in treating severe carpal tunnel syndrome and patient satisfaction related to hospital experience after knee or hip replacement; innovations in rotator cuff repair and the role of cell therapy; timelines for a patient’s return to activity after surgery to correct progressive collapsing foot deformity (PCFD); the use of biomechanics to improve joint replacement outcomes; new imaging technology to help guide the management of adolescents with scoliosis; a novel anterior cruciate ligament (ACL) reconstruction technique performed in children and adolescents at high risk for re-tears, and more.

HSS Study Offers Timelines for Return to Activity After Major Foot Surgery

An HSS study led by Scott J. Ellis, MD, foot and ankle surgeon, and colleagues, provides attainable goals for return to sports and related physical activities for patients who have undergone procedures to correct progressive collapsing foot deformity (PCFD), a severe musculoskeletal pathology that can drastically inhibit a patient’s daily function. Study data will be used to provide patients with realistic expectations and timelines to resume activities post-surgery and as a resource at the time when surgery is being discussed.

Searching for New Cell-Therapy Innovations in Rotator Cuff Repair

A thought leadership piece by Scott A. Rodeo, MD, sports medicine surgeon, discusses innovations in rotator cuff repair, specifically the role of cell therapy, and how the HSS Center for Regenerative Medicine has a robust research program that is investigating the basic cellular and molecular mechanisms of healing damaged tissue.

HSS Study Reveals Why Men are More Likely to Be Offered Surgery for Carpal Tunnel Syndrome

HSS research led by Duretti Fufa, MD, hand and upper extremity surgeon, suggests males presented with more severe carpal tunnel syndrome and were offered surgery more often than females with the condition. 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.

New Study Finds Black Patients Less Likely to be Completely Satisfied with Care After Knee or Hip Replacement

A collaborative HSS study that included Susan M. Goodman, MD, rheumatologist, and Mark P. Figgie, MD, chief emeritus of the Surgical Arthritis Service, found that Black patients were less likely than white patients to be completely satisfied with the process of care following knee or hip replacement. Socioeconomic status was not found to play a role in patient satisfaction. The researchers reviewed the Press Ganey survey responses of more than 4,600 patients who had surgery at HSS from July 2010 to February 2012. Individuals having a primary knee or hip replacement who resided in New York, New Jersey or Connecticut were included in the study. Although Black patients indicated they were less satisfied with the process of care right after surgery, there was no difference in satisfaction with their joint replacement outcome. More research is needed to investigate other factors, such as perceived staff courtesy and baseline pain and function, to understand why disparities exist to achieve a high level of patient satisfaction for everyone.

Study Finds Cementless Knee Replacement Outcomes Comparable to Standard Knee Implant, Less Time Needed in OR

In a study comparing outcomes of a modern cementless knee implant to the standard knee implant that requires bone cement for fixation, HSS hip and knee surgeons Geoffrey H. Westrich, MD, Brian P. Chalmers, MD, and colleagues found no difference in hospital length of stay, complications, hospital readmission within 90 days of surgery, or rates of revision surgery at two-year patient follow-up. With respect to time spent in the operating room (OR), researchers found that using the cementless implant reduced OR time by 25%, saving an average of 27 minutes.

HSS Presents New Biomechanics Research at 2022 AAOS Annual Meeting

HSS investigators present new research related to biomechanics and orthopedic surgery, highlighting the unique relationship surgeons have with the engineers to promote the highest quality in patient care and advancing joint replacement for the future. Three studies focus on how to optimize total knee arthroplasty (TKA) surgery using biomechanics and computer modeling, while another study discusses how three-dimensional (3-D) modeling can improve total hip arthroplasty (THA).

New Study Finds Surface Imaging Provides Highly Accurate Models of The Body for Scoliosis Surgeons

A collaborative study by Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS and Howard J. Hillstrom, PhD, a biomechanical engineer at HSS, found that a technique called 3dMD, which uses an array of highly sensitive cameras and can image the entire body in a fraction of a second, generates extremely accurate and reliable models of the torso that can guide the management of adolescents with scoliosis.

New HSS Study Finds Safe and Effective Outcomes After Innovative ACL Reconstruction Technique in Children and Adolescents at High Risk for Re-Tears

HSS research by Daniel W. Green, MD, MS, FAAP, FACS, pediatric orthopedic surgeon and Frank A. Cordasco, MD, MS, sports medicine surgeon, evaluated the safety and efficacy of performing a lateral extra-articular tenodesis (LET) using a modified Lemaire technique (MLT) in conjunction with an ACL reconstruction in children and adolescents who are at an increased risk for a failed ACL reconstruction. Findings revealed the technique was associated with favorable patient-reported outcomes, high return to sports participation and low ACL re-tear rate.

Carpal Tunnel Can Happen Even Without A Desk Job

Sun, 17 Jan 2021 08:41:00 -0500

The Palm Beach Post’s “Ask the Expert” column features Michelle G. Carlson, MD, hand and upper extremity surgeon at HSS, discussing the causes and treatment of carpal tunnel.

Dr. Carlson explained while carpal tunnel is a natural part of aging, certain gripping activities (e.g., working in the garden, playing the piano repeatedly, etc.), can increase the risk. Activities involving wrist flexion (e.g., driving a car, reading a newspaper, etc.), also increases symptoms.

Wrist splints help at night and during symptom causing activities, as they align the bones that form that ‘C’ into the biggest possible arc, providing room for the nerve and tendons. Rest also decreases swelling around the tendons.

Dr. Carlson advised to see a specialist if symptoms don’t resolve in two weeks to evaluate the condition and rule out other causes. Oftentimes a cortisone injection provides temporary relief, and occasionally nerve tests are ordered if the diagnosis is in question. Carpal tunnel can be cured by a small surgical solution under local anesthesia to open the ligament forming the top of the tunnel.

This article appeared in the print edition on January 17, 2021.