Carpal tunnel decompression. The impact of tourniquet, anaesthesia type, and operating team on patient satisfaction scores.

Carpal tunnel syndrome is a frequently encountered cause of upper extremity discomfort and disability, with an annual incidence of 0.1% in the general population and over 2% in high-risk occupations. A large proportion of patients fail to respond to conservative treatment with wrist splints, analgesics, lifestyle modification and corticosteroid injection. In this group of patients, surgical release of the flexor retinaculum is indicated in order to decompress the carpal tunnel, as first described by Learmonth in 1933. Surgical decompression of the carpal tunnel can be performed under local or general anaesthetic and with or without a tourniquet. A variety of techniques have been described, each with its individual merits and drawbacks. The increasing role of clinical governance in modem day practice places an even greater emphasis on the need to establish whether specific interventions meet patients’ expectations. Previous studies have evaluated outcome following surgical decompression of the carpal tunnel using physical findings, disease specific questionnaires, and electromyography, with reported success rates ranging from 70 to 90%. We used a validated patient completed questionnaire to assess patient satisfaction following unilateral and bilateral carpal tunnel decompression in a large sample of patients in a district general hospital setting. We also investigated the impact of anaesthesia type, tourniquet usage and operating team on the clinical outcome. All patients in the study group were diagnosed by a consultant hand surgeon, using a mixture of clinical history, clinical tests and EMG recordings.