Surgical intervention for carpal tunnel syndrome in individuals with spinal cord injuries-patient characteristics, diagnostic considerations, and treatment outcomes

A retrospective chart audit. To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making. Swiss Paraplegic Centre, Nottwil, Switzerland. Retrospective investigation of medical history, diagnostics, surgeries, and outcomes of surgi...

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Bibliographic Details
Published in:Spinal cord series and cases 2021-02, Vol.7 (1), p.9-9, Article 9
Main Authors: Pallaver, Armin, Schibli, Silvia, Fridén, Jan
Format: Article
Language:English
Subjects:
Carpal tunnel syndrome
Carpal Tunnel Syndrome - diagnosis
Carpal Tunnel Syndrome - epidemiology
Carpal Tunnel Syndrome - surgery
Decision making
Female
Humans
Male
Median Nerve
Paralysis
Retrospective Studies
Spinal cord
Spinal Cord Injuries - complications
Spinal Cord Injuries - diagnosis
Spinal Cord Injuries - surgery
Surgery
Treatment Outcome
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Summary:A retrospective chart audit. To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making. Swiss Paraplegic Centre, Nottwil, Switzerland. Retrospective investigation of medical history, diagnostics, surgeries, and outcomes of surgical treatments of CTS in patients with para- and tetraplegia. We identified a total of 77 surgeries for CTS in 55 patients: 16 females (25 surgeries) and 39 males (52 surgeries) with spinal cord injury. The majority (47 persons, 68 surgeries) were paraplegic (level of lesion Th2 and below); 8 persons (9 surgeries) were tetraplegic (level of lesion Th1 and above). ASIA scores in the tetraplegic group were A: 0, B: 1, C: 4, D: 3 while complete lesions predominated in the paraplegic group (A: 32, B: 4, C: 5, D: 6). Sixty-six out of 77 patients reported total relief of symptoms. Neither nerve conduction velocity nor motor amplitude correlated well with the severity of CTS. Co-morbidity and specific risk factors were rare. SCI patients with CTS respond well to surgical decompression of median nerve regardless of level and type of spinal cord lesion and risk factors. Nerve conduction parameters and clinical findings can provide additional diagnostic support of CTS although nocturnal hand paresthesia, wrist pain at and after loading as well as failed conservative treatment are the main indications for surgical interventions. Based on symptomatology, clinical findings, and nerve conduction studies, we propose a decision-making tree for suggesting surgery or not.
ISSN:2058-6124
2058-6124
DOI:10.1038/s41394-020-00379-x