“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 (CTS) and Dupuytren's contracture (DC) results in an increased incidence of Complex Regional Pain Syndrome (CRPS). As a result, many surgeons do not perform surgery for the two conditions concurrently. Our goal was to determine the extent of this association. Methods: We identified all patients undergoing surgical treatment for CTS, DC, or both between April 1982 and March 2017 using the Indiana Network for Patient Care (INPC), a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year post-operative incidence of CRPS were recorded. Results: A total of 51,739 (95.6%) patients underwent carpal tunnel release (CTR) only, 2,103 (3.9%) underwent palmar fasciectomy (PF) only, and 305 (0.6%) underwent concurrent CTR and PF. There was no difference in the likelihood of developing CRPS (p=0.163) between groups. Independent risk factors for developing CRPS were younger age, anxiety, depression, epilepsy, gout, and history of fracture of the radius, ulna, or the carpus. Conclusions: Concurrent CTR and PF is not associated with an increased risk for developing CRPS. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of CRPS after surgery and should be discussed preoperatively as potential risk factors. Financial Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received for this article. Presented at: The 2018 Annual Meeting of the American Association of Hand Surgery Acknowledgements: The authors would like to acknowledge Katie Bickett from the Regenstreif Institute for her role in building the database from the Indiana Network for Patient Care used for this investigation and Lava Timsina for his help with the statistics. Corresponding author: Joshua M. Adkinson, M.D., Division of Plastic Surgery, Department of Surgery, 545 Barnhill Drive, Emerson Hall (EH), Suite 232, Indianapolis, IN 46202, (317) 880-8580, jadkinso@iu.edu ©2018American Society of Plastic Surgeons

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