JHS - 2026-04-01 - Journal Article
Surgical Management of Wrist Arthritis Is Linked to Increased Carpal Tunnel Syndrome/Carpal Tunnel Release Risk: Rethinking Preoperative Evaluation.
Mzeihem M, Foy M, Alvarez J, Nyaaba W, Gonzalez MH
Topics
Key Takeaway
Wrist arthritis patients undergoing corrective surgery develop CTS at 26.4% versus 7.0% in conservatively managed controls at 1 year (OR 4.06), with CTR rates of 17.7% versus 2.3% (OR 8.25), and PRC carries the highest adjusted odds for both outcomes.
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Summary
This study used the PearlDiver database to compare CTS and CTR incidence in wrist arthritis patients undergoing 4CF, PRC, wrist fusion, or total wrist arthroplasty versus comorbidity-matched conservatively managed controls, excluding all patients with prior CTS or CTR. At 1 year, surgical patients had 26.4% CTS incidence versus 7.0% in controls (OR 4.06) and 17.7% CTR rate versus 2.3% (OR 8.25). Risk was highest in the first 6 months postoperatively; 4CF had the highest raw incidence while PRC carried the greatest adjusted odds of CTS (OR 3.33) and CTR (OR 6.04) after multivariate analysis.
Key Limitation
Database methodology cannot determine whether CTS was truly procedure-induced or represented subclinical pre-existing disease unmasked by postoperative swelling and carpal morphology change, limiting causal inference.
Original Abstract
PURPOSE
This study aimed to determine whether patients with wrist arthritis undergoing corrective surgeries, such as 4-corner fusion (4CF), proximal row carpectomy (PRC), wrist fusion, or total wrist arthroplasty, have a higher incidence of carpal tunnel syndrome (CTS) and subsequent carpal tunnel release (CTR) compared with those managed nonsurgically.
METHODS
The PearlDiver database was used to identify two patient groups: the surgical group (patient with wrist arthritis who underwent corrective surgery) and the conservative group (patients with wrist arthritis who did not have surgery). Exclusion criteria included prior CTS or CTR. The surgical group was matched to the conservative and control groups based on age, gender, diabetes, hypothyroidism, and the Elixhauser Comorbidity Index. CTS and CTR incidence were analyzed using the chi-square test.
RESULTS
Of 2.5 million patients with wrist arthritis, those undergoing surgical intervention (n = 18,125) had significantly higher rates of CTS and CTR than the matched conservative cohort. At 1 year after surgery, 26.4% of surgical patients developed CTS versus 7.0% in the conservative group (OR, 4.06), with CTR rates of 17.7% versus 2.3% (OR, 8.25; P < .05). These elevated risks persisted up to 2 years and were highest within the first 6 months after surgery. Among surgical procedures, 4CF was associated with the highest incidence of CTS and CTR, though multivariate analysis revealed PRC had the greatest adjusted odds of both outcomes, respectively (OR, 3.33; OR, 6.04).
CONCLUSIONS
Patients with wrist arthritis who undergo surgery face higher risks of CTS and subsequent CTR than those managed conservatively. Among procedures, 4CF showed the highest incidence, whereas PRC carried the highest adjusted odds after accounting for comorbidities. These findings emphasize the need to recognize carpal tunnel morphologic changes during surgery and support preoperative screening and potential prophylactic measures to reduce postoperative median nerve compression.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic II.