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Medical Factors
Return to work after carpal tunnel surgery

At a glance:
This study examined the factors that affect a workers recovery and return to work after carpal tunnel release surgery. Unlike previous research, which examined whether a patient had returned to work as a measure of their recovery, this study asked how well patients could function in their job, 2 and 6 months after surgery. The authors found that many factors combine to affect how well a patient will function at work after surgery. Confidence in managing their symptoms and a supportive work environment are important in an effective return to work.
When people are confident about their ability to manage their condition they do better. Make sure you speak to your treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 to get a good understanding of your condition, the natural course of it, and what you can do to manage your problem.

Many factors influence recovery and return to work. This study asked people about a broad range of factors that can influence the results of surgery and return to work. It found that feeling confident about the condition and the ability to manage symptoms influences outcomes.
The major factors influencing people's recovery and their ability to function productively in the workplace are the workplace environment and the person's confidence in their ability to manage the condition. A workplace that's supportive, cares for people, and provides some flexibility in work activities is associated with better patient recovery, return to work and productivity outcomes.
This study shows that people with carpal tunnel do better if they have a supportive workplace and feel confident about the problem.

Patient confidence occurs when they understand the condition and can voice concerns, so that they feel assured that they can deal with the condition. Make sure people understand the nature of the problem, and feel comfortable about dealing with any issues.

Other studies have shown that training in problem-solving can help people with musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 problems. Understanding the difference between "hurt" and "harm" also helps people's confidence in returning to function.
Outcomes for this relatively common problem are improved by workplace support and the patient's confidence regarding their condition.

Encourage employees who have had carpal tunnel and other musculoskeletal problems to ensure they understand its nature, the likely path forward and what they can do to return to normal function.
Original Article, Authors & Publication Details:
B. C. Amick, R. V. Habeck, J. Ossmann, A. H. Fossel, R. Keller and J. N. Katz (2004).

Predictors of Successful Work Role Functioning After Carpal Tunnel
Carpal Tunnel
A tunnel at the wrist made up of the wrist bones and a strong ligament.
fibrous tissue
Collection of cells that perform a similar function. e.g. epithelium (skin), connective tissue (blood, bone), muscle
 that connects bones to other bones
  See carpal tunnel syndrome.
 Release Surgery.
Journal of Occupational and Environmental Medicine; 46:490-500

From the University of Texas, School of Public Health, Houston, Texas (Drs Amick and Ossmann); the Texas Program for Society and Health, Rice University, Houston, Texas (Dr Amick); the Institute for Work and Health, Toronto, Ontario Canada (Dr Amick), W. E. Upjohn Institute for Employment Research, Kalamazoo, Michigan (Dr Habeck); the Robert Brigham Arthritis and Musculoskeletal Clinical Research Center, Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Womens Hospital, Boston, Massachusetts (Ms Fossel and Dr Katz); and the Maine Spine and Rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 Center, Portland, Maine (Dr Keller).
Background, Study Objectives, How It Was Done:
If a person returns to work after injury or illness it is often assumed that they have fully recovered. However, that person may be back at work without having regained full function, and may have further absences from work in the future. If an employee misses work, productivity is clearly lost, while if an employee is functioning poorly at work lost productivity is more difficult to measure.

This study aims to measure the outcome of treatment in a way that is meaningful to the workplace, by determining the “work role functioning' in employees who have returned to work after carpal tunnel surgery.

250 000 people per year in the United States have carpal tunnel release surgery. Surgery can significantly reduce the symptoms of carpal tunnel syndrome
Carpal Tunnel Syndrome
A condition characterized by pain and numbness in the hand and sometimes the forearm. It is caused by pressure on the nerve which connects the arm to the hand (through the carpal tunnel) and gives sensation to the hand, thumb and three fingers
 and speed return to work. Workers compensation claims for carpal tunnel surgery
Carpal Tunnel surgery
A treatment for carpal tunnel syndrome. Surgery relieves pressure on the nerve connecting the arm to the hand, relieving symptoms.
 are common, and usually last longer and cost more than claims for other musculoskeletal injuries.

Patients with carpal tunnel syndrome
A group of symptoms that together are characteristic of a specific disorder or disease
 who were working at least 20 hours per week were identified in 15 clinics between April 1997 and October 1998. Patients were excluded if they were younger than 18, pregnant, or full-time students. 197 patients agreed to participate, and completed an initial questionnaire before their surgery. They were mailed a questionnaire two, six and 12 months after their operation. 122 patients who reported their work role functioning before surgery and two and/or six months after surgery were included in the study. The data from 12 months was not included as only 80 participants returned the questionnaire.

Work role functioning:

To assess work role functioning patients were asked the percentage of the time they found it difficult to meet work demands due to physical or emotional problems in the past week. They were asked how often they could meet the following 15 work situations:

Work Scheduling Demands:

1. Sticking to your work routine or schedule
2. Doing your work without needing frequents rests or breaks

Psychological Demands:

3. Concentrating on your work
4. Remembering things having to do with your work

Social Demands:

5. Talking with people in person, in meetings or on the phone.
6. Helping others to get work done
7. Controlling irritability or anger toward people when working

Physical Demands:

8. Lifting, carrying or moving objects at work
9. Bending, twisting or reaching
10. Using hand-operated tools or equipment (for example, pen, drill, sander, keyboard or computer mouse)
11. Keeping your body in one position longer than 30 minutes at a time

Output Demands:

12. Doing your work without making mistakes
13. Satisfying those people who judge your work
14. Finishing all your work
15. Feeling a sense of accomplishment

The scale was from 1 (0% of the time) to 5 (100% of the time), or “does not apply to my job'.

From their responses the patients in the study were divided into three groups:

Those who had not returned to work.
Those who were able to meet the demands of their job less than 90% of the time.
Those who were able to meet the demands of their job 90% of the time or more.

Other variables:

Other variables asked about in the questionnaire were:

Age, gender, education, income (individual and household)
Clinical variables (symptom severity, change in symptoms/function, type of surgery)
Psychosocial variables (confidence in managing symptoms, depression,
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 social/family support, marital and parental status)
Economic/legal variables (workers compensation claim or litigation underway)

Job conditions:

The amount of hand and wrist force used in the patients job and how repetitious the movements were was assessed. Patients with high force and high repetition were called “high risk'.

Patients were also asked about their job security, social support at work (from workmates and supervisors), and job control.

Organisational conditions:

In the initial questionnaire patients were asked whether their employer accommodated their injury by:

Arranging for others to help
Changing work times
Adding rest breaks
Arranging for the worker to learn new skills
Supplying new tools or equipment

Employer size, safety practices and whether the patient was a union member were asked. This information was used to group patients into “high support organisation' and “low support organisation' groups.

Only six patients changed employers during the study.
Study Findings:
At the initial questionnaire:

29% of patients were able to meet the demands of their job 90% of the time or more according to their work role functioning response
Symptom severity and upper limb
upper limb
 function significantly affected work role functioning.
A number of variables were not related to work role functioning:

o Type of surgery
o Gender, marital status, family size, percent of household income provided by the patient
o Union membership, employer size, psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 job demands, job security, job accommodation

After two months:

Factors (assessed before surgery) associated with a better work role functioning score 2 months after surgery were:

Better work role functioning before surgery
Not being depressed or obese
Better physical health
Not claiming workers compensation
Having a less physically demanding job
High job control
Having a workplace with supportive organisational practices

Better physical health correlated with better work role functioning before surgery.

Several other variables weren't significant on their own but contributed to a higher work role functioning scores:

Family social support
Having a specific type of carpal tunnel surgery (bilateral)
Work social support
Severity of symptoms before surgery

After six months:

In addition to the factors found to effect work role functioning after two months, factors (assessed before surgery) associated with a better work role functioning score six months after surgery were:

Confidence in managing symptoms
Improvement of symptoms
Family social support
Not pursuing litigation
Work social support

Having a supportive work organisation correlated with high job control.

Several other variables weren't significant on their own but contributed to a higher work role functioning scores:

Having a specific type of carpal tunnel surgery (bilateral)
Having multiple pain sites

After adjusting for work role function prior to surgery only improved confidence in managing symptoms and having a supportive work organisation significantly improved functioning at work.
This study examined the effect of clinical, worker, family, economic/legal, job and organisational factors in a worker's recovery, and return to work after carpal tunnel release surgery. Unlike previous research, which used whether a patient had returned to work (or time taken to return to work) as a measure of their recovery, this study asked how well the patients were functioning, two and six months after surgery. Patients who functioned well in their role at work before surgery were more likely to function well at work two months after surgery, while those who were depressed, obese or seeking workers compensation were less likely to function well.

Patients who were confident they could manage their symptoms and were working in a supportive organisation were more likely to have good function at work six months after surgery.

This research suggests that some factors are more important for good functioning after a return to work in the short-term, while some factors are more important in the longer term.

This study highlights the importance of a supportive work environment and improving patient confidence to maintain successful functioning at work.
PubMed Abstract
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