New law breaks promises made when workers’ comp began                     

Wednesday, March 23, 2005                                                 

Michael Maguire                                                            

By the time you read this, the governor will probably have signed the workers’ compensation bill. His signature will mark the betrayal of working people in Missouri who were made a promise nearly 80 years ago that they would be treated fairly if they agreed to accept workers’ compensation.

Keep in mind this is not a needed change. The statistics from our Division of Workers’ Compensation show that insurance companies are making record returns on their premiums, which means they are not having to pay out much.

It is also not an attempt to be friendly to employers, as the Missouri Chamber of Commerce and Industry argues, although any time the chamber speaks up when you are talking about people’s rights––look out. If that were the case, this change could have been handled like it has since I started practicing law in Missouri in 1986: by getting the two sides together and coming up with a solution. For the last three years, those representing employees have tried to get insurance companies and employers to work on their complaints. They refused to do anything meaningful, biding their time until they had control of the legislature and the governor.

A little history is worth remembering. When the workers’ comp system was set up––in exchange for having a required mechanism that would provide medical care if you were hurt doing your job, provide some money if you could not work and provide payments if you had some disability as a result of your injuries––workers gave up certain rights:

1. They lost their right to sue their employers in regular court.

2. They lost the right to pick the doctor who would treat them––as the employer (read that to mean insurance company) gets to pick.

3. Artificial caps were placed on the amounts a worker could receive for weekly benefits and for permanency benefits.

4. Employees could not be awarded any damages for just pain and suffering, although someone who loses a hand or a leg or suffers any kind of work injury will readily tell you it hurts like hell.

Part of the promise made so many years ago was a presumption in favor of the employee, meaning that if all things were equal, meaning it was a tie on the proof, that the decision should go to the worker. Employers knew that and signed off on that when they set up this system. Now because of
this manufactured business-unfriendly crisis, that presumption is gone. The burden of proof for a worker has been changed from the work being a substantial factor of the injury to the prevailing factor.

Administrative law judges have faithfully followed the promise and interpreted the law, and because businesses don’t like what that means, they are putting politics into the process. Those judges will now be reviewed every two years, and if they don’t come up to standards, which will be determined by––guess who––pro-employer types, then they are out of a job.

Never mind that employers have two bites of the apple if they don’t like a decision of the judge. They get to appeal to the Labor and Industrial Relations Commission. And if that does not work, they can appeal to the Court of Appeals. I consider this provision alone character assassination of the fine men and women who routinely handle thousands of cases as judges and legal advisors with great intelligence and diligence.

Part of what this cadre has done is to change lawyers’ fees. Yes, I am an lawyer. And, yes, I handle cases of employees. I admit I will be looking at cases more closely, because the new law says if the company makes an offer and it is rejected, then my fee can only be a percentage of the amount I recover above that offer. If I take a case and it takes little or no work, I have no problem with that theory. However, if the usual case occurs and the employer makes the case go on for months, requiring extra work and I have to try the case, then it is not fair to me or to the employee to limit that award.

I believe, and always have, that the law is supposed to be fair––not too much for one side or the other. I know the employers and their cronies in the legislature have not given back to employees their rights they gave up when they created workers’ comp. The promise has been broken, and the
owners get all the benefits. The workers get the shaft.

Don’t be surprised after all these changes go into effect that nothing happens to the premiums paid by employees. I have said all along that the cyclical nature of insurance companies investing premiums in the stock market has more to do with higher premiums than any $6-an-hour line worker filing a claim for carpal tunnel syndrome.

If you think this is wrong and unfair to the working man and woman, let the governor and our local senator and representatives and the lieutenant governor know, because they all supported this promise breaking.

Michael H. Maguire of Cape Girardeau is a lawyer.

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Font SizeA A A Spinal fusion (arthrodesis)
Spinal fusion (arthrodesis) is a surgical procedure that joins, or fuses, two or more vertebrae. Spinal fusion is major surgery, usually lasting several hours. There are different methods of spinal fusion.

Bone is taken from the pelvic bone or obtained from a bone bank. The bone is used to make a bridge between adjacent vertebrae. This bone graft stimulates the growth of new bone.
Metal implants are secured to the vertebrae to hold them together until new bone grows between them.
What To Expect After Surgery
You will need to be watched in the hospital for a few days after spinal fusion surgery.

Bed rest is not usually necessary during your recovery period at home.

Your doctor may recommend that you wear a back brace during recovery.

Rehabilitation can be a prolonged process and includes walking, riding a stationary bike, swimming, and similar activities.

Why It Is Done
Spinal fusion may be done by itself or in combination with decompression to treat painful symptoms caused by misalignment or instability of the vertebrae, such as spondylolisthesis.

Spinal fusion may also be done as a follow-up to decompression and debridement procedures done to treat spinal stenosis, herniated discs, spinal injuries, infection, tumors, and deformities.

How Well It Works
This surgery was originally developed as a way to stabilize the spine and treat deformity or fractures of the spine. Its use has now spread to treatment of degenerative bone or disc changes and spinal stenosis. 1

Spinal fusion is often necessary to stabilize the spine after a traumatic injury, infection, or tumor. There is no solid body of research supporting the effectiveness of spinal fusion for various other spinal conditions. One study showed no clear difference between spinal fusion surgery and intensive rehabilitation for treating chronic low back pain. 2 In addition, the surgery is expensive and has significant risks. Therefore, although this type of surgery is common, it is controversial, and there is no guarantee of treatment success.

Risks
The risks associated with this procedure vary depending upon your age and overall health, diagnosis, and the type of procedure that is done.

Spinal fusion procedures frequently cause other problems. Risks include:

Pain at the bone graft site.
Failure of the fusion process and/or breakage of metal implants.
Deep venous blood clots that may also lead to pulmonary embolism.
Nerve injury.
Graft rejection.
Superficial infection.
Deep infection.
What To Think About
Because there are so many things to consider when spinal fusion is recommended, seek a second opinion before making a decision.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Citations
Deyo RA, et al. (2004). Spinal-fusion surgery-The case for restraint. New England Journal of Medicine, 350(7): 722–726.

Fairbank J, et al. (2005). Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: The MRC spine stabilisation trial. BMJ, 330(7502): 1233–1239.

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer William M. Green, MD – Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD – Orthopedics
Last Updated February 6, 2008
WebMD Medical Reference from Healthwise
Last Updated: February 06, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

Back Pain Health Center

Font Size  Below is a great article about making the decision whether or not to have surgery.  JEFF SWANEY FREE CONSULTATION 314-481-7778

A

A

A

Interactive Tool: Should I Consider Surgery for My Low Back Problem? – What does this tool measure?

Click here to find out whether surgery may help reduce the symptoms of a back problem.

This interactive tool will not diagnose a back problem, but it will tell you whether surgery might help reduce or get rid of symptoms related to your low back problem. There are always risks with any surgery, so most people don’t want to have surgery unless there is a very good chance it will help them. Although research shows that surgery is very likely to be effective for some problems, it rarely helps with others.

This tool will help you find out whether your own low back problem might be helped by surgery. After you use this tool, you can show the results to your doctor when you talk to him or her about surgery and your other options.

This tool is not meant for people in emergency situations. Talk to your doctor immediately if you have any of the following problems:

• Bladder and/or bowel problems, including not being able to go to the bathroom as you normally do or not being able to control bowel movements or urination
• Loss of feeling or rapidly decreasing feeling over your feet and heels or in your “saddle area,” which includes any part of your body that might touch a saddle if you were on a horse, including your buttocks, your inner thighs, and the backs of your legs
• Increasing pain, weakness, numbness, or problems with coordination in one or both legs
• A fever for 2 or more days
• A serious injury, an accident, or a big fall in the last 2 weeks
• A history of spinal stenosis
• A history of cancer

We are all concerned about Chrysler’s injured workers. Here is a recent article I found. Jeff Swaney FREE CONSULTATION 314-481-7778

States watch Chrysler’s possible impact on workers’ comp

Roberto Ceniceros
Business Insurance
May 11, 2009 – 1:31 pm ET

NEW YORK — States are carefully monitoring Chrysler LLC’s bankruptcy case for its possible impact on workers’ compensation funds.

Indeed, Michigan’s workers’ compensation guaranty fund for self-insured employers would be exhausted if Chrysler reneges on its pledge to keep paying workers’ comp claims despite its Chapter 11 bankruptcy filing, according to the state’s attorney general.

In a court filing last week, Michigan Attorney General Mike Cox stated that Michigan’s Self-Insurers’ Security Fund could face insolvency as a result of Chrysler’s April 30 Chapter 11 filing and attempt to sell its assets to Italian automaker Fiat S.p.A.

Other states where Chrysler self-insures its comp liabilities say they also are monitoring the action, despite assurances from Chrysler that it will continue to pay its workers’ comp claims.

A Chrysler spokesman said the troubled automaker has court authority to keep paying workers’ comp liabilities owed to injured employees across the country.

As of Dec. 31, Chrysler had 38,257 U.S. employees. It purchases workers’ comp insurance in some states while self-insuring in others, according to various state regulator databases.

Objecting to language

Cox filed a motion in the U.S. Bankruptcy Court for the Southern District of New York, which is handling the Chrysler bankruptcy, last week objecting to some of the language in Chrysler’s bankruptcy filings. He said filings show there is potential for Chrysler and a buyer of its assets to disregard the auto manufacturer’s existing workers’ comp obligations.

The company’s recent court pleadings “may be interpreted as an intention to no longer meet such statutory obligations,” the attorney general’s motion states.

Proposed sale documents specifically reject a successful bidder’s assumption of Chrysler workers’ comp liabilities, so it appears an entity would not be left to make payments to injured Chrysler workers, the attorney general said.

The attorney general filed the motion on behalf of the Michigan Workers’ Compensation Agency and Funds Administration, which regulates self-insureds and oversees the security fund.

“If [Michigan's] Self-Insurers Security Fund was forced to assume [Chrysler's] workers’ compensation obligations, enough funds exist only to make benefit payments for a matter of weeks before this fund becomes insolvent itself,” the motion said.

“The concern…applies not only to [Chrysler's] injured employees, but to all injured employees in Michigan entitled to benefits from an insolvent self-insured employer,” the motion states. “If the proposed sale order is approved and the debtors are unable or unwilling to continue paying their workers’ compensation obligations, the Self-Insurers’ Security Fund would eventually become insolvent.”

The attorney general’s motion also said other self-insured employers in Michigan could face additional assessments to help shore up the security fund in their state, but that would fall short.

Emergency assessments?

Michigan risk managers are concerned their self-insured programs would face an emergency assessment to make up for a security fund shortfall should Chrysler fail to meet its obligations, said Leigh Stepaniak, director of risk management for the Wayne County Airport Authority, Detroit Metropolitan Airport.

Such an assessment would be difficult given economic conditions, said Stepaniak, who also is a member of the board of managers for the Michigan Self-Insurers’ Association.

“We are all looking at our budgets, which are extremely tight, and we are looking at our own losses, and if they do any emergency assessment it is going to impact us,” Stepaniak said

Even if emergency assessments were levied, the fund’s “maximum possible balance would be approximately $9 million — substantially less than needed to cover the debtors’ statutory obligations,” according to the attorney general’s motion.

Chrysler’s workers’ comp liability potentially exceeds $150 million and requires the company to expend more than $25 million annually, according to the attorney general.

The Michigan Self Insurer’s Security Fund paid out nearly $5 million in benefits in 2008. There were 470 individually self-insured employers in the state, according to the Workers’ Compensation Agency’s 2008 annual report.

Officials in other states where Chrysler self-insures workers’ comp liabilities said they were reviewing the Michigan Attorney General’s filing to see if any action might be appropriate.

Illinois, too

“We have been talking to our attorney [general's office] about our options and we are monitoring the Michigan situation,” said a spokeswoman for Illinois Workers’ Compensation Commission, which supervises self-insureds and operates a security fund. “We are talking with workers’ comp agencies [in Indiana, Missouri and Ohio] to see what they are doing,” the Illinois spokeswoman said. “But we don’t have any conclusions as of now.”

A spokeswoman for Missouri’s Department of Labor said they too are monitoring the situation and “will respond as more information becomes available regarding the bankruptcy filing.”

The Ohio Bureau of Workers’ Compensation expects that Chrysler will continue meeting its workers’ comp obligations because of the bankruptcy court judge’s approval to allow Chrysler to do so, a spokeswoman said.

Chrysler assured her several weeks ago that it would pay its workers’ comp claims, said Linda Hamilton, chairman of the Workers’ Compensation Board of Indiana in Indianapolis.

“There is concern, but Chrysler contacted us a number of weeks ago about what possibly may happen,” Hamilton said. “They made sure that they [addressed] all of their outstanding obligations for injured workers.”

Chrysler asked for the bankruptcy judge’s permission to continue paying its workers’ comp claims even before Michigan filed its motion.

While the judge has approved Chrysler’s request to continue paying its workers’ comp claims during bankruptcy, he did not rule on the Michigan Attorney General’s objection, a spokesman for Mr. Cox said.

“I’m not going to criticize the Michigan Attorney General, nor am I going to point out whether the Michigan Attorney General’s motion had any veracity at all,” a Chrysler spokesman said. “But we went to the court and the court has given us the authority to pay and we will pay our workers’ comp obligations to employees around the country.”

By: Peter F. Ullrich, Jr., MD Font sizeAAA
Fig 1: X-ray of pedicle screws in place (lateral view)
(larger view) A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery, and all involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment.

For patients with the following conditions, if abnormal and excessive motion at a vertebral segment results in severe pain and inability to function, a fusion may be considered :

Article continues below
Degenerative disc disease

Isthmic, degenerative or postlaminectomy spondylolisthesis.

Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis or deformity.

How spine fusion surgery works

At each level in the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment and permit multiple degrees of motion. Two vertebral segments need to be fused together to stop the motion at one segment, so that an L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is actually a one-level spinal fusion.

More Spinal Fusion Info:

Cervical Spinal Fusion

Lumbar Spinal Fusion

Fusion Surgery Recovery

Bone Grafts
A spine fusion surgery involves using bone graft to cause two vertebral bodies to grow together into one long bone. Bone graft can be taken from the patient’s hip (autograft bone) during the spine fusion surgery, harvested from cadaver bone (allograft bone). or manufactured (synthetic bone graft substitute).

In general, a lumbar spinal fusion surgery is most effective for those conditions involving only one vertebral segment. Most patients will not notice any limitation in motion after a one-level spine fusion. Only in rare cases should a three (or more) level fusion surgery for pain alone be considered, although it may be necessary in cases of scoliosis and lumbar deformity.

When necessary, fusing two segments of the spine may be a reasonable option for treatment of pain. However, spinal fusion of more than two segments is unlikely to provide pain relief because it removes too much of the normal motion in the lower back and places too much stress across the remaining joints.

There are several types of spinal fusion surgery options, including:

Posterolateral gutter fusion—the procedure is done through the back

Posterior lumbar interbody fusion (PLIF/TLIF))—the procedure is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

Anterior lumbar interbody fusion (ALIF)—the procedure is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

Anterior/posterior spinal fusion—the procedure is done from the front and the back
This is an excellent article that I ran accross. Jeff Swaney Free Consultation 314-481-7778
It is important to note that with any type of spine fusion surgery, there is a risk of clinical failure (meaning that the patient’s pain does not go away) despite achieving a successful fusion. Obtaining a successful result from a spine fusion requires and accurate preoperative diagnosis, a technologically adept surgeon, and a patient with a reasonably healthy lifestyle (non smoker, non obese) who is motivated to pursue rehabilitation and restoration of their function.

An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.

transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome.open carpal tunnel release surgery.local anesthetic and you can go home on the same day.

When you return to work depends on whether the dominant hand (the hand you use most) was involved, on your work activities, and on the effort that you put into rehabilitative physical therapy.

In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

1

2risks of general anesthesia. But most open carpal tunnel surgery is done with local anesthesia or regional block rather than with general anesthesia.

Both endoscopic and open carpal tunnel release have benefits and risks. Studies do not show that one procedure is better than the other. Talk to your doctor about your options.

32 Should I have surgery for carpal tunnel syndrome? surgery information form (PDF)

PDF document?)

Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

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Open carpal tunnel surgery for carpal tunnel syndrome

An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.

See a picture of open carpal tunnel release surgery.

If you have open carpal tunnel release surgery, you usually do not need to stay in the hospital. It is usually done under local anesthetic and you can go home on the same day.

What To Expect After Surgery

After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. You may be directed to wear a splint for several weeks. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to 3 months.

When you return to work depends on whether the dominant hand (the hand you use most) was involved, on your work activities, and on the effort that you put into rehabilitative physical therapy.

• If you have surgery on your nondominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days, although 7 to 14 days is most common.
• If you have surgery on your dominant hand and do repetitive activities at work, you may require 6 to 12 weeks for a full recovery before you can return to previous work duties. Physical therapy may speed your recovery.

Why It Is Done

Open carpal tunnel surgery is considered when:

• Symptoms are still present after a long period of nonsurgical treatment. In general, surgery is not considered until after 3 to 12 months of non-surgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
• There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
• Tumors or other growths need to be removed.

How Well It Works

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery. More than 70 out of 100 people are satisfied with their results, and as many as 90 out of 100 people have no night pain after surgery. ¹

In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

Risks

The risk and complication rates of open surgery are very low. Major problems such as nerve damage happen in fewer than 1 out of 100 surgeries (less than 1%). ² There is a small risk that the median nerve or other tissues may be damaged during surgery. After open surgery, recovery may be slower than after endoscopic surgery, and there may be some pain in the wrist and hand. You may also have some tenderness around the scar. There are also the risks of any type of surgery, including possible infection and risks of general anesthesia. But most open carpal tunnel surgery is done with local anesthesia or regional block rather than with general anesthesia.

What To Think About

Open carpal tunnel surgery cuts open the base of the palm and requires a longer recovery period than endoscopic surgery. Painful scar tissue may be more likely to develop after open surgery than after endoscopic surgery. ³

Both endoscopic and open carpal tunnel release have benefits and risks. Studies do not show that one procedure is better than the other. ² Talk to your doctor about your options.

Should I have surgery for carpal tunnel syndrome?

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Citations

1. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.
2. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
3. Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Carpal Tunnel Syndrome Health Center

• Topic Overview
• Health Tools
• Cause
• Symptoms
• What Happens
• What Increases Your Risk
• When To Call a Doctor
• Exams and Tests
• Treatment Overview
• Prevention
• Home Treatment
• Medications
• Surgery
• Other Treatment
• Other Places To Get Help
• Related Information
• References
• Credits

Related to Carpal Tunnel Syndrome

• Arthritis
• Find a Physical Therapist
• Office Ergonomics
• Pain Management
• Rheumatoid Arthritis Videos

Hot Topics in Carpal Tunnel Syndrome

• RA Quiz: How to Protect Your Joints
• 7 Carpal Tunnel Syndrome Symptoms
• 4 Ways to Ease Wrist Pain
• Are You Depressed? Check Your Symptoms.
• What’s Causing Your Joint Pain?

Open carpal tunnel surgery for carpal tunnel syndrome

During open carpal tunnel release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome.

An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.

See a picture of open carpal tunnel release surgery.

If you have open carpal tunnel release surgery, you usually do not need to stay in the hospital. It is usually done under local anesthetic and you can go home on the same day.

What To Expect After Surgery

After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. You may be directed to wear a splint for several weeks. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to 3 months.

When you return to work depends on whether the dominant hand (the hand you use most) was involved, on your work activities, and on the effort that you put into rehabilitative physical therapy.

• If you have surgery on your nondominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days, although 7 to 14 days is most common.
• If you have surgery on your dominant hand and do repetitive activities at work, you may require 6 to 12 weeks for a full recovery before you can return to previous work duties. Physical therapy may speed your recovery.

Why It Is Done

Open carpal tunnel surgery is considered when:

• Symptoms are still present after a long period of nonsurgical treatment. In general, surgery is not considered until after 3 to 12 months of non-surgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
• There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
• Tumors or other growths need to be removed.

How Well It Works

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery. More than 70 out of 100 people are satisfied with their results, and as many as 90 out of 100 people have no night pain after surgery. ¹

In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

Risks

The risk and complication rates of open surgery are very low. Major problems such as nerve damage happen in fewer than 1 out of 100 surgeries (less than 1%). ² There is a small risk that the median nerve or other tissues may be damaged during surgery. After open surgery, recovery may be slower than after endoscopic surgery, and there may be some pain in the wrist and hand. You may also have some tenderness around the scar. There are also the risks of any type of surgery, including possible infection and risks of general anesthesia. But most open carpal tunnel surgery is done with local anesthesia or regional block rather than with general anesthesia.

What To Think About

Open carpal tunnel surgery cuts open the base of the palm and requires a longer recovery period than endoscopic surgery. Painful scar tissue may be more likely to develop after open surgery than after endoscopic surgery. ³

Both endoscopic and open carpal tunnel release have benefits and risks. Studies do not show that one procedure is better than the other. ² Talk to your doctor about your options.

Should I have surgery for carpal tunnel syndrome?

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Citations

1. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.
2. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
3. Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	William M. Green, MD – Emergency Medicine
Specialist Medical Reviewer	Patrick J. McMahon, MD – Orthopedics
Specialist Medical Reviewer	David Pichora, MD, FRCSC – Orthopedic Surgery
Last Updated	October 29, 2008

WebMD Medical Reference from Healthwise

Last Updated: October 29, 2008

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

• What is Carpal Tunnel Syndrome?
• RA or OA: How to Tell the Difference

Carpal Tunnel Syndrome Health Center

• opic Overview
• Health Tools
• Cause
• SymptomsWhat Happens
• What Increases Your Risk

Related to Carpal Tunnel Syndrome

• Arthritis
• ind a Physical Therapist
• Office Ergonomics
• Pain Management
• Rheumatoid Arthritis Videos

Hot Topics in Carpal Tunnel Syndrome

• RA Quiz: How to Protect Your Joints
• 7 Carpal Tunnel Syndrome Symptoms
• 4 Ways to Ease Wrist Pain
• Are You Depressed? Check Your Symptoms.
• What’s Causing Your Joint Pain?

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  Open carpal tunnel surgery for carpal tunnel syndrome

  During open carpal tunnel release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome.

  An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.

  See a picture of open carpal tunnel release surgery.

  If you have open carpal tunnel release surgery, you usually do not need to stay in the hospital. It is usually done under local anesthetic and you can go home on the same day.

  What To Expect After Surgery

  After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. You may be directed to wear a splint for several weeks. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to 3 months.

  When you return to work depends on whether the dominant hand (the hand you use most) was involved, on your work activities, and on the effort that you put into rehabilitative physical therapy.

  • If you have surgery on your nondominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days, although 7 to 14 days is most common.
  • If you have surgery on your dominant hand and do repetitive activities at work, you may require 6 to 12 weeks for a full recovery before you can return to previous work duties. Physical therapy may speed your recovery.

  Why It Is Done                                     Submitted by Jeff Swaney Free Consultation 314-481-7778

  Open carpal tunnel surgery is considered when:

  • Symptoms are still present after a long period of nonsurgical treatment. In general, surgery is not considered until after 3 to 12 months of non-surgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
  • Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
  • There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
  • Tumors or other growths need to be removed.

  How Well It Works

  Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery. More than 70 out of 100 people are satisfied with their results, and as many as 90 out of 100 people have no night pain after surgery. ¹

  In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

  If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

  Risks

  The risk and complication rates of open surgery are very low. Major problems such as nerve damage happen in fewer than 1 out of 100 surgeries (less than 1%). ² There is a small risk that the median nerve or other tissues may be damaged during surgery. After open surgery, recovery may be slower than after endoscopic surgery, and there may be some pain in the wrist and hand. You may also have some tenderness around the scar. There are also the risks of any type of surgery, including possible infection and risks of general anesthesia. But most open carpal tunnel surgery is done with local anesthesia or regional block rather than with general anesthesia.

  What To Think About

  Open carpal tunnel surgery cuts open the base of the palm and requires a longer recovery period than endoscopic surgery. Painful scar tissue may be more likely to develop after open surgery than after endoscopic surgery. ³

  Both endoscopic and open carpal tunnel release have benefits and risks. Studies do not show that one procedure is better than the other. ² Talk to your doctor about your options.

  Should I have surgery for carpal tunnel syndrome?

  Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

  Citations

  1. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.
  2. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
  3. Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

  Author	Shannon Erstad, MBA/MPH
  Editor	Kathleen M. Ariss, MS
  Associate Editor	Pat Truman, MATC
  Primary Medical Reviewer	William M. Green, MD – Emergency Medicine
  Specialist Medical Reviewer	Patrick J. McMahon, MD – Orthopedics
  Specialist Medical Reviewer	David Pichora, MD, FRCSC – Orthopedic Surgery
  Last Updated	October 29, 2008

WebMD Medical Reference from Healthwise

Last Updated: October 29, 2008

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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(What is a to help you prepare for this surgery.