Temporary disability has been substantial and continues to be the main source of cost of carpal tunnel syndrome nationally. In fact, Carpal tunnel is the leading cost of disability payments-even more than low back pain! There has been a strong drive towards cost reduction in the treatment of carpal tunnel syndrome, doing whatever is possible to get a person back to their job as quickly as possible at the greatest capacity possible is the most important. With endoscopic carpal tunnel release, where return to work has been looked at, return to work after surgery is significantly faster with fewer complaints in recovery than in patients who have undergone open carpal tunnel release.
Open carpal tunnel release in my opinion is best at this point called filet-of-wrist. The differences in the recovery between endoscopically treated and open carpal tunnel release patients highlights this. A classic study comparing endoscopic with open carpal tunnel release has shown that patients preferred endoscopic over open carpal tunnel release. With the exception of one or two very small poorly controlled studies involving patients treated in countries with socialized medicine and a low work ethic, every study dealing with endoscopic carpal tunnel release which has looked at time to return to work has shown a marked improvement over the patient's long delay in return to work that is characteristically seen after open carpal tunnel release; i.e. several weeks for endoscopic versus months for the open carpal tunnel release group.
In the United States, getting a patient to return to work after a problem that has been accepted on a worker's compensation; i.e. blamed upon their job can be a very difficult project. My patients treated at the Carpal Tunnel Relief Center with ascientific protocol, optimum medication to prevent and treat discomfort when it occurs, and a proprietary exercise protocol without formal physical or occupational therapists have routinely been returning to work within one day of endoscopic carpal tunnel release over the past eleven years. It is necessary to get the cooperation of the employer because while many jobs don't require any specific restrictions, some jobs will have to be modified either in the volume that their patient is requested to produce or the exact tasks/work station that the person is on during the first few weeks of recovery. The only absolute is that the person must keep her wound clean for about a week in order that it can heal without a chance of infection. We have accomplished this with a very light dressing to keep the wound covered except for showering. There has been no compromise in the result.
On a national basis in the United States, the majority of upper extremity claims for worker's compensation benefits have come from carpal tunnel syndrome frequently misdiagnosed as "tendinitis".
Industrial clinics can't offer a correct diagnosis or definitive treatment and are notorious for this. This is often perpetuated by inappropriate shunting of patients to non-hand specialists for prolonged pseudo therapy in the hope that complaints will go away and possibly in hope that the person will jump ship and find another occupation. This has been a particular problem in the meat packing industry, where there is a tendency to have "in-house" treatment ( i.e. conflict of interest) with physical therapists, nurse practitioners, and a medical director who is a non specialist displaced from front line treatment and unable to offer a surgical cure or even temporary comfort.
Psychological factors have a very large overall impact in a person's response to treatment and especially in their willingness to stay at work or return to work after any type of surgery, whether it is hernia repair or carpal tunnel release, etc. People blaming a job for a problem are much more likely to complain more before surgery and after surgery than people who accept a problem as their own, as another aspect of routine life with the need to "get on with it."