COMMENTARY
Commentary on “Trends in Carpal Tunnel Surgery: An Online Survey of Members of the American Society for Surgery of the Hand” As pointed out by the authors of “Trends in Carpal Tunnel Surgery: An Online Survey of Members of the American Society for Surgery of the Hand,” three studies have previously polled hand surgery society members in their approaches to treating carpal tunnel syndrome.1 Due to the prevalence of the disease, information regarding practice trends can broadly inform the hand surgery community and provide a crosssectional view of practice behaviors. Duncan et al2 published the first such study in 1987 and used a lengthy 37-question survey with many of the queries broken down into subsections. Leinberry et al3 provided a 25-year follow-up by using many of the same questions from Duncan et al’s study and identified clear trends in surgical technique. Shin et al4 surveyed members of the American Association for Hand Surgery with 11 questions and detected differences in treatment approaches based on training background. Finally, a fourth carpal tunnel survey study published just last year examined the usage of corticosteroid injections and electrodiagnostic studies in response to Clinical Practice Guidelines recently released by the American Academy of Orthopaedic Surgeons.5 Because of the ubiquity of electronic mailing lists and the ease of obtaining data electronically and anonymously, survey studies have become a popular way to gather information on treatment attitudes for various conditions. In fact, it seems that response rates to surveys are generally lower now than in years past, probably due to “survey fatigue” of the respondents. Nevertheless, surveys help to identify broad trends in our approaches to diseases, particularly when the answers are compared with historical data. Many of the questions used in this survey are similar to the ones described in the report of Shin et al. Questions regarding regional variation, years in practice, surgical approach, anesthesia type, orthosis application, and antibiotic usage were featured in both surveys. This study found that approximately half of the respondents favored a mini-open incision, and a significant minority
772
r
Ó 2015 ASSH
r
Published by Elsevier, Inc. All rights reserved.
used an endoscopic approach. Intraoperative antibiotics were used by 51% of respondents. These data are consistent with the information presented in the previous published studies. In the end, it is not possible to conclude whether one practice approach is superior to another based on surveys. The widespread use of the mini-incision technique, for example, does not prove that endoscopic techniques are less effective. Nevertheless, these findings do reveal the dichotomous nature of our practices despite the widespread prevalence of carpal tunnel syndrome, arguably the most common condition seen in hand surgery practices. Evidence-based guidelines are still lacking, which allows dogmatic views to flourish. I hope that survey studies such as this will stimulate further discussion and instigate the development of higher level studies that can put some of these questions to rest. Eon K. Shin, MD The Philadelphia Hand Center, P.C. Langhorne, PA http://dx.doi.org/10.1016/j.jhsa.2015.01.007 REFERENCES 1. Munns JJ, Awan HM. Trends in carpal tunnel surgery: An online survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2015;40(4):767e771. 2. Duncan KH, Lewis RC Jr, Foreman KA, Nordyke MD. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: Results of a questionnaire. J Hand Surg Am. 1987;12(3):384e391. 3. Leinberry CF, Rivlin M, Maltenfort M, et al. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: A 25-year perspective. J Hand Surg Am. 2012;37(10): 1997e2003. 4. Shin EK, Bachoura A, Jacoby SM, Chen NC, Osterman AL. Treatment of carpal tunnel syndrome by members of the American Association for Hand Surgery. Hand (NY). 2012;7(4):351e356. 5. Lane LB, Starecki M, Olson A, Kohn N. Carpal tunnel syndrome diagnosis and treatment: A survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2014;39(11): 2181e2187.
Commentary on “Trends in Carpal Tunnel Surgery: An Online Survey of Members of the American Society for Surgery of the Hand” As pointed out by the authors of “Trends in Carpal Tunnel Surgery: An Online Survey of Members of the American Society for Surgery of the Hand,” three studies have previously polled hand surgery society members in their approaches to treating carpal tunnel syndrome.1 Due to the prevalence of the disease, information regarding practice trends can broadly inform the hand surgery community and provide a crosssectional view of practice behaviors. Duncan et al2 published the first such study in 1987 and used a lengthy 37-question survey with many of the queries broken down into subsections. Leinberry et al3 provided a 25-year follow-up by using many of the same questions from Duncan et al’s study and identified clear trends in surgical technique. Shin et al4 surveyed members of the American Association for Hand Surgery with 11 questions and detected differences in treatment approaches based on training background. Finally, a fourth carpal tunnel survey study published just last year examined the usage of corticosteroid injections and electrodiagnostic studies in response to Clinical Practice Guidelines recently released by the American Academy of Orthopaedic Surgeons.5 Because of the ubiquity of electronic mailing lists and the ease of obtaining data electronically and anonymously, survey studies have become a popular way to gather information on treatment attitudes for various conditions. In fact, it seems that response rates to surveys are generally lower now than in years past, probably due to “survey fatigue” of the respondents. Nevertheless, surveys help to identify broad trends in our approaches to diseases, particularly when the answers are compared with historical data. Many of the questions used in this survey are similar to the ones described in the report of Shin et al. Questions regarding regional variation, years in practice, surgical approach, anesthesia type, orthosis application, and antibiotic usage were featured in both surveys. This study found that approximately half of the respondents favored a mini-open incision, and a significant minority
772
r
Ó 2015 ASSH
r
Published by Elsevier, Inc. All rights reserved.
used an endoscopic approach. Intraoperative antibiotics were used by 51% of respondents. These data are consistent with the information presented in the previous published studies. In the end, it is not possible to conclude whether one practice approach is superior to another based on surveys. The widespread use of the mini-incision technique, for example, does not prove that endoscopic techniques are less effective. Nevertheless, these findings do reveal the dichotomous nature of our practices despite the widespread prevalence of carpal tunnel syndrome, arguably the most common condition seen in hand surgery practices. Evidence-based guidelines are still lacking, which allows dogmatic views to flourish. I hope that survey studies such as this will stimulate further discussion and instigate the development of higher level studies that can put some of these questions to rest. Eon K. Shin, MD The Philadelphia Hand Center, P.C. Langhorne, PA http://dx.doi.org/10.1016/j.jhsa.2015.01.007 REFERENCES 1. Munns JJ, Awan HM. Trends in carpal tunnel surgery: An online survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2015;40(4):767e771. 2. Duncan KH, Lewis RC Jr, Foreman KA, Nordyke MD. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: Results of a questionnaire. J Hand Surg Am. 1987;12(3):384e391. 3. Leinberry CF, Rivlin M, Maltenfort M, et al. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: A 25-year perspective. J Hand Surg Am. 2012;37(10): 1997e2003. 4. Shin EK, Bachoura A, Jacoby SM, Chen NC, Osterman AL. Treatment of carpal tunnel syndrome by members of the American Association for Hand Surgery. Hand (NY). 2012;7(4):351e356. 5. Lane LB, Starecki M, Olson A, Kohn N. Carpal tunnel syndrome diagnosis and treatment: A survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2014;39(11): 2181e2187.
