Impact of Adding Carpal Tunnel Release or Trigger Finger Release to Carpometacarpal Arthroplasty on Postoperative Complications

Pdf Summary

Thumb carpometacarpal (CMC) osteoarthritis is common—affecting up to 7% of men and 15% of women, and over 30% of postmenopausal women—and can cause significant pain, weakness, and functional limitation. When nonoperative management (splinting, NSAIDs, steroid injections) fails, CMC arthroplasty is a frequent surgical option. Many patients also have concurrent hand conditions such as carpal tunnel syndrome or trigger finger, raising the question of whether it is safe to “bundle” procedures (carpal tunnel release and/or trigger finger release) during the same operative session.<br /><br />This retrospective database study used IBM MarketScan claims (2012–2016) to compare outcomes for adults undergoing CMC arthroplasty alone versus CMC arthroplasty with concurrent carpal tunnel and/or trigger finger release. The cohort included 22,074 patients (mean age 59; 76% women): 18,010 had CMC-only surgery and 4,064 had multiple procedures. In the multiple-procedures group, 74% had carpal tunnel release, 20% trigger finger release, and 6% both.<br /><br />Primary outcomes included persistent opioid use (opioid use 60–180 days postoperatively among opioid-naïve patients), 30-day readmissions (ED visits), 30-day wound complications, and complex regional pain syndrome (CRPS) within one year. Compared with multiple procedures, CMC-only surgery showed slightly lower persistent opioid use (16% vs 18%) and readmissions (3% vs 4%). Adjusted analyses found reduced odds for CMC-only patients for persistent opioid use (OR ~0.85–0.86) and readmission (OR 0.80). Pain was the most common readmission reason (16%). Complication and CRPS rates did not significantly differ, though the study was underpowered for these rarer outcomes.<br /><br />Conclusion: adding carpal tunnel and/or trigger finger release to CMC arthroplasty modestly increases the risk of persistent opioid use and short-term readmission, so the convenience of combined surgery should be weighed against these small but measurable risks.

Keywords

thumb CMC osteoarthritis

carpometacarpal arthroplasty

concurrent procedures

carpal tunnel release

trigger finger release

IBM MarketScan claims database

persistent postoperative opioid use

30-day readmission emergency department visit

wound complications

complex regional pain syndrome (CRPS)