R S Miller

Carpal tunnel syndrome in primary care: a report from ASPN. Ambulatory Sentinel Practice Network.

BACKGROUND Carpal tunnel syndrome (CTS) is a common condition in primary care, yet little is known about its presentation and management. This study was designed to provide a better understanding of the frequency of CTS in a primary care population, and its presentation, diagnosis, and management. METHODS Clinicians in 74 Ambulatory Sentinel Practice Network (ASPN) practices from 30 states and three Canadian provinces collected data on all patients presenting with symptoms of CTS during a 30-month period. RESULTS The adjusted frequencies of all visits and of first visits for symptoms of CTS were 1.01 and 0.68 per 1000 patient visits, respectively. Women visited more frequently than men with new onset symptoms of CTS (0.81 vs 0.55 per 1000 visits), and homemakers accounted for 15.9% of all new cases. Clinicians judged 43.1% of all CTS incident visits to be job-related. The diagnostic evaluation of patients seldom included nerve conduction studies (12.9%) or electromyography (11.8%). The most frequent treatments were splints (56.3%) and nonsteroidal anti-inflammatory agents (50.8%). Four-month follow-up data were obtained for 68.5% of the patients, and symptom relief was reported by 55.2% of patients. Ninety percent of patients were able to continue working at the same job, and 96% were able to continue their usual activities. CONCLUSIONS Carpal tunnel syndrome symptoms are common in primary care, and most cases occur among women, many of whom are homemakers. Most patients with CTS symptoms are treated conservatively by their primary care clinicians with minimal testing or referral, and most patients report improvement or resolution of symptoms at 4 months.