Return to work after carpal tunnel release: what should we advise our patients?

Abstract

Carpal tunnel syndrome is a common condition associated with pain and altered sensation in the hand. Treatment includes carpal tunnel release surgery (CTR). Many individuals undergoing CTR work in paid roles, yet there is limited guidance for returning to work after their surgery. The aims of this thesis were: to identify and appraise the existing research and current clinical practice that is pertinent to return to work after CTR; and, to identify the outcomes and experiences of CTR patients who are workers.

Four studies were included: 1) a systematic review of reported return to work times after CTR; 2) a survey of the practice and return to work recommendation of UK hand surgeons and hand therapists; 3) a prospective multi-centre cohort study of patients undergoing CTR; and 4) a qualitative interview study of patients who had returned to work after CTR. Across the 55 studies identified in the systematic review, the duration of work absence ranged from 4-168 days. Occupational information was poorly reported.

A variety of CTR pathways were reported by the 272 clinicians who completed the survey. There was wide variation in the recommended return to work times for specific job roles. The cohort study recruited 167 participants from 16 sites. The median work absence was 21 days (range 1-99). Factors associated with return to work time included: sex, smoking status, belief that symptoms were caused by work, computer-use and expected duration of sick leave. Earlier return to work was not associated with poorer outcomes. The return to work experiences of 14 interviewees were summarised in three themes. The first described a mismatch between expectation and experience: carpal tunnel release is not a ‘minor’ procedure. The second focused on the prescription of sick leave: need for a valid reason to be off work. The third centred on the practicalities of the return to work process: how to handle the return.

In conclusion, the duration of work absence after CTR varied widely, both in the literature and in practice. Expected duration of work absence was an important determinant of the time taken to return to work. Future collaboration with the UK hand surgery and primary care communities is needed to enable patients to have access to appropriate and consistent return to work advice. Caution is warranted because guidance that primarily focuses on providing timescales for return to work may preclude earlier return to work and function. Practical advice about everyday functioning and strategies to grade workrelated hand use may be more beneficial for patients

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Identifiers

ORCID for Lisa Newington: orcid.org/0000-0001-6954-2981

ORCID for Karen Walker-Bone: orcid.org/0000-0002-5992-1459

ORCID for Joanna Adams: orcid.org/0000-0003-1765-7060

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