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      Análisis de los determinantes que influyen en el retorno al trabajo tras intervención quirúrgica por síndrome del túnel carpiano Translated title: Analysis of the determinants that influence the return to work after surgery for carpal tunnel syndrome

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          Abstract

          Resumen Introducción: el síndrome del túnel carpiano es de importante repercusión en el ámbito laboral, debido a su alta prevalencia, reconociéndose recientemente como enfermedad profesional. Tras la cirugía de liberación del nervio, es de interés valorar los parámetros que repercuten en el retorno al trabajo. Objetivos: revisar la literatura existente relativa al estado funcional de trabajadores previo a ser intervenidos quirúrgicamente por síndrome del túnel carpiano, y su reincorporación laboral analizando los factores de mayor influencia sobre ésta. Material y métodos: revisión sistemática de artículos publicados entre 2009-2019 en bases de datos, escogiéndose los artículos en base a criterios de inclusión y exclusión que abarcaban factores con repercusión en la vuelta al trabajo tras una cirugía del síndrome del túnel carpiano. Resultados: se seleccionan 13 estudios observacionales, excluyéndose 1 metaanálisis, 9 revisiones sistemáticas, 20 ensayos clínicos y 1 opinión de expertos. Se analizan en mayor medida factores como el tiempo de retorno, tipo de cirugía empleada, compensación económica y sintomatología. Conclusión: se sugiere una evidencia limitada en la asociación entre los factores analizados y el retraso en el retorno a la actividad profesional. La evaluación posterior al tipo de cirugía empleada muestra la compensación económica como el parámetro de mayor predominancia.

          Translated abstract

          Abstract Introduction: carpal tunnel syndrome is of great impact in the workplace, due to its high prevalence, recently being recognized as an occupational disease. After the nerve release surgery, it is of interest to assess the parameters that affect going back to work. Objectives: to review the existing literature regarding the functional status of workers prior to undergoing surgery for carpal tunnel syndrome, and their reinstatement, analyzing the factors with the greatest influence on it. Material and methods: systematic review of articles published between 2009-2019 in databases, choosing the articles based on inclusion and exclusion criteria that includes factors with an impact on going back to work after a carpal tunnel syndrome surgery. Results: 13 observational studies were selected, excluding 1 meta-analysis, 9 systematic evaluations, 20 clinical trials and 1 expert opinion. To analyze to a greater extent factors such as the time of return, type of surgery used, economic compensation and symptomatology. Conclusion: there was limited evidence in the association between the factors analyzed and the delay in the return to professional activity. The evaluation after the type of surgery used shows the economic compensation as the parameter of greater predominance.

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          Carpal Tunnel Syndrome: Diagnosis and Management.

          Carpal tunnel syndrome, the most common entrapment neuropathy of the upper extremity, is caused by compression of the median nerve as it travels through the carpal tunnel. Classically, patients with the condition experience pain and paresthesias in the distribution of the median nerve, which includes the palmar aspect of the thumb, index and middle fingers, and radial half of the ring finger. Additional clues include positive physical examination findings, such as the flick sign, Phalen maneuver, and median nerve compression test. Although patients with typical symptoms and signs of carpal tunnel syndrome do not need additional testing, ultrasonography and electrodiagnostic studies are useful to confirm the diagnosis in atypical cases and rule out other causes. If surgical decompression is planned, electrodiagnostic studies should be obtained to determine severity and surgical prognosis. Conservative treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome. Options include splinting, corticosteroids, physical therapy, therapeutic ultrasound, and yoga. Nonsteroidal anti-inflammatory drugs, diuretics, and vitamin B6 are not effective therapies. Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year. Patients with severe carpal tunnel syndrome or whose symptoms have not improved after four to six months of conservative therapy should be offered surgical decompression. Endoscopic and open techniques are equally effective, but patients return to work an average of one week earlier with endoscopic repair.
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            Determinants of return to work after carpal tunnel release.

            The determinants of time to return to work-a common measure of treatment effectiveness-are incompletely defined. Our primary hypothesis was that employment circumstances are the strongest determinant of earlier return to work. Our secondary hypothesis was that return to work in patients with desk-based jobs is predicted by patient expectations and other psychosocial factors. We enrolled 65 employed patients with limited incision open carpal tunnel release in a prospective cohort study. Patients completed validated measures of depression, coping strategies, pain anxiety, and job burnout. Heavy lifting was not allowed for 1 month after surgery. Return to modified and full work duty was recorded in days. Although not specifically an exclusion criterion, none of the patients had a workers' compensation claim or other source of secondary gain. Patients returned to modified duty an average of 11.8 days and full duty at an average of 18.9 days after surgery. Predictors of earlier return to modified duty in multivariate analyses included desk-based work and both the number of days patients expected to take off and the numbers of days they wanted to take off for the entire cohort, with an additional influence from catastrophic thinking in desk-based workers. Predictors of earlier return to full duty in multivariate analyses included desk-based work and number of days patients expected to take off before for the entire cohort, fewer days off desired in non-desk-based workers, fewer days off desired and change in work role in desk-based workers, and lower pain anxiety in part-time workers. The most important determinant of return to full duty work after limited incision open carpal tunnel release is job type, but psychological factors such as patient expectations, catastrophic thinking, and anxiety in response to pain also have a role. Prognostic II. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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              Sickness Absence from Work among Persons with New Physician-Diagnosed Carpal Tunnel Syndrome: A Population-Based Matched-Cohort Study

              Background Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. Methods In Skåne region in Sweden we identified all subjects, aged 17–57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004–2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27–45) for women and 41 days (IQR 28–50) for men. Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis. Gender differences were small.
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                Author and article information

                Journal
                mesetra
                Medicina y Seguridad del Trabajo
                Med. segur. trab.
                Escuela Nacional de Medicina del Trabajo. Instituto de Salud Carlos III (Madrid, Madrid, Spain )
                0465-546X
                1989-7790
                March 2020
                : 66
                : 258
                : 26-46
                Affiliations
                [2] Madrid orgnameH.U Infanta Leonor España
                [3] Madrid orgnameHospital General Universitario Gregorio Marañón Spain
                [4] País Vasco orgnameH.U Barrualde-Galdakao España
                [1] Madrid orgnameH.U 12 de Octubre España
                Article
                S0465-546X2020000100026 S0465-546X(20)06625800026
                85760207-b6a7-4f9e-8cf4-6fe2108749c1

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 04 March 2020
                : 18 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 21
                Product

                SciELO Spain

                Categories
                Revisión Sistemática

                liberación del túnel carpiano,síndrome del túnel carpiano,carpal tunnel release,worker,cirugía,trabajador,carpal tunnel syndrome,going back to work,surgery,retorno al trabajo

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