We read with interest the report of Katz et al. [1997] regarding predictors of return to work following carpal tunnel release (CTR). We agree with the authors that a variety of psychosocial factors can potentially affect the return-to-work interval following CTR. The experience of Shor and Miller [1996] suggests that 25% of treatment is to pathology of the condition and 75% revolves around biopsychosocial interactions. Katz et al. [1997] did not consider one such biopsychosocial interaction, which we consider important, in their return-to-work predictions: the health care providerpatient relationship. Our experience with rehabilitation of CTR patients is that almost all who are managed closely following CTR surgery can return to their usual occupations within several days to 2 weeks of surgery [Nathan et al., 1993].
Prior to surgery, we address the psychosocial aspects of the procedure, educating patients about the normal sequelae of the surgical intervention. Specifically, we inform patients that carpal tunnel surgery is an uncomplicated procedure and that discomfort experienced in the initial postoperative phase is a routine consequence of the procedure and not indicative of an unresolved problem or a disabling condition. We set a specific time frame for release for work and we ask patients to agree to participate actively in postoperative rehabilitation. A physical therapy rehabilitation program begins the day after surgery and is used not only to promote healing and mobilization of the extremity, but also to provide psychological support and encouragement for the