Abstract
Carpal tunnel syndrome requiring decompression is common at the world’s largest lamb processing plant. However there is little to guide us in advising patients on return to heavy manual work postoperatively. The purpose of this study was to establish current New Zealand practice and whether expeditious return to work was possible.
Following informed consent a retrospective review of those with neurophysiologically-confirmed carpal tunnel syndrome requiring decompression over four seasons was performed. Open, day-case surgery was performed in all cases by the senior author. Patient demographics, time to return to work, further absenteeism, pain-free interval and complications were examined. A prospective study in the subsequent season was then performed. Additional information gathered for previous seasons pre and 6 week postoperatively included QuickDASH, SF36, grip-strength visual analogue pain, paraesthesiae and numbness scores. Student’s t-test was used for statistical analysis. An email survey of the NZOA was also performed.
One hundred percent follow-up was achieved. In the retrospective group 281 in 187 patients were performed. The average time to return to light duties/rehabilitation was 11 (9 – 42) days. The mean pain free interval was 24 (10 – 63) days. Return to full-duties was on average 28 (10 – 70) dayswith three patients (1% of the total cohort) requiring further time off. Ninety-nine percent returned to their previous role. There were two infections. In the prospective group in this study, 26 hands underwent decompression in 13 patients. The average return to light duties/rehabilitation was 13 (10–25) days and to full duties 32 (21–56) days. Ninety-two percent returned to their previous role and there was one superficial infect ion. The improvement in mean total QuickDASH scores (total score possible 300) were from 140 points (standard deviation 63: 95% CI 101–178) to 68 (standard deviation 54; 95% CI 34–100) and this was statistically significant (p< 0.01). The difference in Short Form 36 scores was not statistically significant (p = 0.6). The differences in numbness, pain and paraesthesiae visual analogue scores were all statistically significant at 6 weeks after surgery (p< 0.01, p< 0.01 and p=0.01 respectively). All patients felt that the operation had been overall worthwhile and at the time of submission none had taken any further time off work. Examining lamb boners as a separate group and using Survival and Cox regression analysis the average return to full working duties for lamb boners was 29 days which is significantly different to New Zealand Orthopaedic surgical practice.
The unique population at this plant has allowed a culture to develop whereby early return to light duties after removal of sutures is expected. This culture, good patient education, and coordinated efforts at all levels of the care pathway are undoubtedly necessary for this level of achievement.
Correspondence should be addressed to Associate Professor N. Susan Stott, Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand.
