Disability outcomes in a worker's compensation population: surgical versus nonsurgical treatment of carpal tunnel syndrome.

A retrospective record review of patients with occupational carpal tunnel syndrome, nerve conduction velocity studies, and a closed Workers' Compensation case was undertaken to compare the outcome of surgical versus nonsurgical treatment with respect to disability and return to work status. Between January 1, 1991, and December 31, 1993, 182 patients who met the inclusion criteria were identified. Surgical release of the carpal tunnel was performed in 57% of patients and the other 43% were treated conservatively. Overall, 82% of patients returned to full work status, whereas 18% had duty modifications. Surgical treatment decreased the rate of duty modifications and disability ratings compared with nonsurgical treatment and reduced the odds of incurring disability. Severity of carpal tunnel syndrome was also a significant factor affecting disability. Despite the generally held belief that the outcome of treatment of occupational carpal tunnel syndrome is poor, the present study shows that both surgical and nonsurgical treatment is effective. However, patients treated with surgery had decreased disability when compared with those who were treated conservatively.

Alternative approaches to the management of priapism.

Herein we describe the use of intracavernous methylene blue (MB), a guanylate cyclase inhibitor, or internal pudendal artery embolization for the treatment of priapism. Eleven patients with priapism were treated from 1993-1996. Etiologies of priapism included PGE1/papaverine (3), trazodone (2), and sickle cell disease (1), in the other five cases the causes the cause was unknown. The average duration of priapism was 27 h for all patients (6-72 h). Five patients who failed intracavernous MB or an alpha-adrenergic agonist, underwent unilateral or bilateral pudendal artery embolization. The average duration of priapism for patients undergoing embolization was 43 h. Sixty-seven percent of the patients treated with MB responded with immediate detumescence. One-hundred percent of patients with priapism secondary to intracavernous injection therapy or trazodone responded. Of the five patients who underwent embolization, 40% achieved immediate pain relief and subsequent detumescence. The three non-responders exhibited a partial detumescence over 47-72 h. After follow-up of one year embolization available for only two patients revealed that one regained potency while the other remained impotent. These results confirmed that MB is effective for pharmacologically-induced priapism. Embolization is a less invasive option for refractory priapism, although results are less than satisfactory in men with priapism of several days duration.