Out of the 60 million records that reside in the PearlDiver database (which includes patients being treated for extremities, spine, trauma, hips, and knees) CTS accounts for a whopping 1.7 million records. That quantity makes CTS one of the most common reasons patients visit their physician and puts it in the top five diagnoses among all extremity categories. The carpal tunnel is a small space in the bones of the wrist that contains ligamenture. It acts as a passageway for the median nerve and tendons that extend from the forearm to the hand.
Carpal tunnel syndrome is the name attached to the patient’s experience of tingling, numbness, weakness, and pain in the fingers, thumb, and wrist, and sporadically in the forearm. CTS may be occurring more and more often at the same time that it is gaining wider recognition. Its prevalence is likely going to continue to rise due to many factors that are associated with the modern lifestyle.
There are many causes of CTS, but the most common are simple day-to-day activities that cause pressure on the median nerve and in some manner restrict the blood supply to the hand. These activities can be anything from using a computer to driving a car, from brushing teeth to putting on make-up, and more. Activities that involve repetitive hand use, especially when the wrist is bent, are the main cause of CTS. Other contributing factors are rheumatoid arthritis associated with wrist arthritis, diabetes, tumor, wrist injuries, swelling of the tendon sheath (which decreases space in the carpal tunnel), smoking, obesity, and osteoarthritis around the wrist section.
While surgery is an option for treating CTS, it is usually reserved for only the most severe cases, such as those that cause disability or, despite weeks of conservative care, don’t respond to treatment. The goal of CTS surgery is to enlarge the carpal tunnel and thereby decrease the pressure on median nerve. Of course, nonsurgical treatments are preferred, and usually do the trick to relieve the pressure and pain from the wrist and hand.
Looking specifically at the PearlDiver database, we noticed that females are diagnosed with CTS more frequently than are males. Table 1 displays data from 2005 (2006 data is now available for PearlDiver subscribers) showing that females were diagnosed almost three times more often than males.
Table 1 — ICD-9 Code 354.0 (Carpal Tunnel Syndrome) by Gender and Region of the U.S.
Chart 1 — Carpal Tunnel Syndrome Occurrences by Gender
In terms of age, the PearlDiver database showed that incidence of CTS generally increased with age. Starting from about 10 years of age, incidence rose continuously until age reached the early 50s. After that, however, both genders showed a steep decline in incidence of CTS starting at age 60.
The most commonly proscribed procedure following a diagnosis of carpal tunnel syndrome is an outpatient procedure. The following table lists the top 10 procedures following a CTS diagnosis.
Doctors and physicians try to treat CTS without any surgical procedures. However, in cases where the syndrome is persistent and worse, neuroplasty with or without transposition is the most commonly performed procedure, accounting for 55% of the patients who receive surgery. Table 2 shows the demographics in region and gender for 2005 (2006 is available for PearlDiver subscribers). Since the diagnosis rate is significantly higher in females, the frequency of surgical procedures tends to be relatively higher in females as well.
Table 2 — CPT Code 64721 (Neuroplasty and/or Transposition, Median Nerve at Carpal Tunnel) by Gender and Region of the U.S.
Chart 2 — Neuroplasty Occurrences by Gender
According to the PearlDiver database, patients between 50 and 60 years were the age group most commonly treated surgically. Having said that, our data showed a decline in neuroplasty procedures from 2004 to 2005..
The second most commonly performed procedure to treat carpal tunnel is an injection—typically a local anesthetic or a corticosteroid. Table 3 and Chart 3 show the demographics of injection procedures by gender and U.S. region. The South and Midwest regions tend to rely on injections much more than the Northeast and the West. Just like the neuroplasty procedure, females undergo this procedure in significantly higher numbers than do males.
Table 3 — CPT Code 20526 (Therapeutic Injection [Local Anesthetic, Corticosteroid], Carpal Tunnel) by Gender and Region of the U.S.
Chart 3 — Therapeutic Injection Occurrences by Gender
The PearlDiver database shows that the occurrence of therapeutic injection in 2005 increased significantly compared with 2004. For both genders, the greatest incidence of injections for CTS occurred in patients in their 50s. Ages below 15 years showed almost no incidence of injection for CTS at all for either males or females.
In conclusion, carpal tunnel syndrome is a growing and increasingly common problem. The facts and figures presented here from the PearlDiver database show that women are diagnosed with CTS almost three times as often as men. The reason for this disparity is still unclear, but studies have indicated that, on average, women have a smaller carpal tunnel than men.
According to the PearlDiver database, CTS mostly occurs in people aged between 30 years and 60 years. Children are diagnosed with CTS too, but not as often as adults. CTS, as a diagnosis, occurs among an exceptionally broad range of ages although, clearly, is concentrated in females. Treatment can range from simple therapy to surgery, depending upon the severity of the syndrome.
Typically, the first line of treatment is nonoperative—i.e., medication or splinting or other nonoperative approaches. In those cases, however, where non-operative treatments fail to relieve CTS, then, we know from the PearlDiver database, that neuroplasty, which is a sophisticated surgical procedure, is performed in more than 50% of cases.