Timing of Carpal Tunnel Syndrome Treatment Based on Social Deprivation

This study sought to investigate the impact of the area deprivation index (ADI) on the treatment timeline from carpal tunnel syndrome (CTS) to carpal tunnel release (CTR). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery.

This is a retrospective review of patients diagnosed with CTS who underwent CTR at a single academic institution. Variables including gender, race, ethnicity, smoking status, medical comorbidities, ADI, timing of visits and surgery, and electrodiagnostic (EDX) studies were collected. The analysis included univariate chi-square tests, ANOVA, and multivariate linear and logistic regressions.

In total, 501 patients were divided by ADI national percentiles from least to most deprived tertiles. Univariate analysis demonstrated increased time from EDX to CTR comparing the least and most deprived tertiles (52 days vs. 95 days). On multivariate analysis, this correlation was no longer significant. Multivariate analysis also revealed a non-significant trend towards least deprived ADI correlating with a trial of corticosteroid injections. Injections prior to surgery correlated with an increased time from EDX to CTR and time from initial presentation to CTR. A diagnosis of severe CTS on EDX correlated with a decreased likelihood of corticosteroid injections.

Although previous studies have demonstrated mixed outcome results in CTS, we found that social deprivation does not correlate with delays in the treatment timeline. Factors other than delays in the treatment timeline may be contributing to the potentially worse outcomes in CTS patients with greater social deprivation.