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Patients with low socioeconomic status experience more symptoms before and after surgery for carpal tunnel syndrome (CTS) – a compressed median nerve in the wrist

Malin Zimmerman. Foto

Although surgery is performed with a simple procedure that is performed under local anesthesia, new research by post doc Malin Zimmerman at Lund University shows that socioeconomic factors such as income, education and/or occupation, have an impact on general recovery and outcome after surgery.

-The results from my research show that patients with different socioeconomic backgrounds recover and benefit equally from a surgery but socioeconomically deprived patients perceive their symptoms and disability after surgery as worse than groups with higher socioeconomic status, says Malin who is a researcher in hand surgery at Lund University and orthopedist at Helsingborg Hospital.
For this interview SRA Epihealth asks Malin to explain to the reader what carpal tunnel syndrome, CTS, is. - The carpal tunnel is a canal that sits in the wrist. The so-called median nerve goes through the canal and runs along the arm out to the hand. For various reasons, the space in the tunnel can be reduced and, in this way, the median nerve can become pinched. She continues,
- Even though more than 90 percent of patients recover from the surgery, it is surprising to see that socioeconomic factors and patient comorbidity affect how patients´ perceive the surgical results, explains Malin. We ask Malin to describe the socioeconomic factors by giving some examples. 
-My research shows that patients who do not have many resources or have a tiring job are less able to cope with the illness. We also see that patients with a low education belong to this category of patients because they often receive health care at a later stage than people with a higher education and at a time when the illness has progressed. Psychological factors also play a role and people with a higher education often have better coping strategies to deal with the illness.   
SRA EpiHealth is interested in knowing how common CTS is and what the risks factors of getting the syndrome are. Malin explains, - CTS affects more than three percent of the Swedish population and it affects both sexes at different ages. Risk factors for the development of CTS and poor treatment outcome include smoking, exposure to vibration, repetitive work, or forceful work as well as combined exposures. Co-morbidities include thyroid disease, rheumatic disease, or diabetes.
During the interview we discuss why a patient´s other illnesses such as diabetes or thyroid disease can make them predisposed to developing CTS. -So far, the causes behind CTS are not fully known but we do know that CTS is affected by hormonal influences from the thyroid and that high blood sugar levels in diabetes is toxic to the peripheral nerves.
We continue the interview by discussing symptoms and treatments. -Symptoms of CTS include pain, numbness, tingling and sensory disturbances in the hand. A simple examination is usually enough to make a diagnosis. The treatment involves reducing the pressure to relieve the nerve. This is done with the help of a splint or cortisone injection. In case of more pronounced symptoms, an operation might be necessary, says Malin. 
- I use patient data from the national quality register for hand surgery (HAKIR). All patients who receive surgery for CTS at hand surgery clinics in Sweden are registered in HAKIR. Patients are asked to fill out a form about their perceived symptoms and disability before surgery and about three to twelve months after the surgery. Some of the questions that the patients are asked concern the functionality of the hand such as the perceived difficulty of opening a can or a tight-fitted lid, carrying grocery bags, washing your back, using a knife to cut the food and so on. It is a rich dataset that I have used in my research. Future research is needed to investigate the factors that may improve treatment outcome for deprived patients.