Combined Carpal Tunnel Release and Palmar Fasciectomy for Dupuytren's Contracture Does Not Increase the Risk for Complex Regional Pain Syndrome.

BACKGROUND

Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome and Dupuytren's contracture results in an increased incidence of complex regional pain syndrome. As a result, many surgeons do not perform surgery for the two conditions concurrently. The authors' goal was to determine the extent of this association.

METHODS

The authors identified all patients undergoing surgical treatment for carpal tunnel syndrome, Dupuytren's contracture, or both between April of 1982 and March of 2017 using the Indiana Network for Patient Care, a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year postoperative incidence of complex regional pain syndrome were recorded.

RESULTS

A total of 51,739 patients (95.6 percent) underwent carpal tunnel release only, 2103 (3.9 percent) underwent palmar fasciectomy only, and 305 (0.6 percent) underwent concurrent carpal tunnel release and palmar fasciectomy. There was no difference in the likelihood of developing complex regional pain syndrome (p = 0.163) between groups. Independent risk factors for developing complex regional pain syndrome were younger age; anxiety; depression; epilepsy; gout; and history of fracture of the radius, ulna, or carpus.

CONCLUSIONS

Concurrent carpal tunnel release and palmar fasciectomy is not associated with an increased risk for developing complex regional pain syndrome. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of complex regional pain syndrome after surgery and should be discussed preoperatively as potential risk factors.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.