The QWERTY keyboard layout dates from 1873, the same as the barbed wire patents which tamed the American west.
A paper from the publication Hand, compared the costs of wrists crippled from Carpal Tunnel Syndrome. In the past, treatments were divided between two options, surgery, or non surgery. In 2006, there were 577,000 carpal tunnel release surgeries, which operation cuts the carpal tunnel ligament. Management of carpal tunnel is either operative (invasive surgery) or nonoperative (non invasive). Costs include lifetime direct and indirect costs, and monetary loss to both patient and the economy. The other nine million carpal tunnel cases are treated with non invasive treatments.
Symptoms of carpal tunnel syndrome include pain, tingling, and numbness. Pain scale is measured zero (none or no pain) to ten (excruciating). The goal is an asymptomatic recovery, returning to a satisfactory quality of life.
Direct Costs
Direct costs for surgeries include fees for physician diagnosis and prognosis, surgeon, anesthesia, therapist, testing, and surgical facility.
Direct costs for treatment, include fees for physician diagnosis and prognosis, therapist, testing and splinting.
Indirect Costs
Indirect costs include ‘lost wages due to inability to work, lower earnings, and missed work. The paper assumed the value of Missed worked calculated on a Median US Salary in 2010 of $41,700 a year, and at 2,080 of work a year, that figures to $20 an hour. The paper ignored indirect costs for doctor’s appointments, postoperative care, therapy sessions, additional prescriptions, surgery, recovery, and return to work factors such as occupation and productivity, patient comorbidities, anxiety and patient expectations.
A summary of the costs for surgery. Surgery has four categories, open, endoscopic, simultaneous bilateral, and staged bilateral. For our purposes, the outcomes for invasive surgeries are combined.
Workdays missed because of pending pre-invasive CTS, are 28 days of work per year per case.
No Risk, success, hooray.
Invasive. Surgical risk. For invasive treatment, 90% of wrist surgeries are considered a success, wherein the wrist became asymptomatic and patient recovers use of the hand. Successful invasive surgical treatment mean costs are in the range of $10,500.
Noninvasive. A third (33%) of noninvasive surgical treatments are successful. About nine million cases are scattered throughout the country. Success is defined as where the wrist and hand pain became asymptomatic and patient recovers use of the hand. The cost of noninvasive physician diagnosis and prognosis, therapist, testing and splinting is $95,000 to $190,000, still excluding many indirect costs listed above. This amounts to about three million patients.
Bad Risks, complications, Not good.
Invasive. With 90% of invasive cases successful, the remaining ten percent (10%) of invasive procedures, i.e. surgery referred to as carpal tunnel release, are ‘complications’. Complications include anesthesia, bleeding, bronchopneumonia, constipation, deep vein thrombosis (DVT), discomforts, infection, intraoperative injuries, nausea, nerve damage, pain, postoperative infections, pulmonary embolism (PE), rash, scar, shock, thromboembolism,
urinary retention, vomiting.
Invasive Infections. Five percent (5%) of complications are infections (one in 200 surgeries). Infections are microbial viruses, bacteria, fungus, and parasites which enter the wound from contaminated blades, blood, or air to feast on the flesh, blood or bone. Infected wounds cost about $5500 more to reopen the release wound and the patient losing another 3 weeks of work to heal from the infection.
Invasive Neuropraxia. Neuropraxia is a mild form of peripheral nerve injury
caused by focal demyelination or ischemia, wherein the conduction of nerve impulses are blocked in the injured area, and motor and sensory conduction is partially or entirely lost.1 A result of loss of sensory conduction is numbness. Neuropraxia is fifteen percent (15%) of complications (3 in 200 surgeries), at a cost $6500 more for losing another 10 days to recover.
Invasive Nerve transection. A nerve transection is an acute deafferentiation with immediate and long standing influence. Afferent nerve fibers transmit information from the peripheral to the central nervous system. In the peripheral nervous system, afferent nerve fibers are part of the sensory nervous system and arise from outside of the central nervous system. Deafferentiation means the nerve has been cut. Nerve transection are one in a thousand surgeries (0.01% overall), at a cost of $38,000, for surgery, revision surgery with nerve repair, and 6 months of missed work. When the
transection cannot be repaired, and the patient’s wrist does not recover, the fingers innervated by the median nerve in the hands have no feeling and become useless. The first year’s cost $50,700, for the surgeries and a year of missed work. And continues at a cost of $41,700 a year until retirement at age 65, plus possible workers’ compensation, of $25,000 a year if any. So a 45 year old patient who has the median nerve cut in a surgery, who does not recover, has a cost of $1.3 million in lost work related income, and needed support.
Invasive persistent symptoms. Persistent symptoms are forty (40%) of
complications, or four in a hundred surgeries. The symptoms persist after original and revision surgery, and a month of missed work. The cost is $9,300, and the suffering which stimulated the surgery continues.
Invasive Scar tenderness. Scar Tenderness symptoms are thirty five percent
(35%) complications, or seven in 200 surgeries. The cost is about $9,800 plus a month of missed work, assuming 20 work days.
Noninvasive treatment. With a third of noninvasive cases successful, the remaining two thirds (67%), include symptoms which remained stable, or worsened. Three fourths (half of the total, ¾ times 2/3 rd ) of these symptoms stabilize at a cost of $3800 a year due to missing two days of work a month. In the remaining one fourth of one third (one sixth) the patient cannot work, so the cost goes to $41,700 in lost wages per year, plus possible workers’ compensation of $25,000, for a total of $66,700 per year, until end of useful working life, assume age 65.
Summary
Based on the partial statistics available, the cost of treating symptoms of Carpal Tunnel Syndrome can be estimated as follows, based on an annual half million surgeries, and nine million more receiving treatment.
The invasive nerve transection, occurring once in a thousand surgeries and based on ahalf million surgeries, or about 500 a year, has an annual cost loss of about $800 million.The rest of complication surgeries, about 49,500 a year, have an annual cost about$10,000 each or an annual cost about a half billion dollars a year.
The successful 450,000 surgeries a year, cost about $450 million a year.
A third (33%) of noninvasive surgical treatments are successful, or three million a year at a cost of between $100 and $200 thousand a year, for a cost of $300 billion a year, which cost is absorbed in the national medical insurance and industry.
The cost of workers’ compensation is $1 per $100 of payroll. The national payroll of wages and salaries is $10.5 Trillion for 2023. So 1% is $105 Billion for workers compensation. Of workers comp premiums, about $2 billion is for carpal tunnel syndrome, which is a third of the occupational RSIs.