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Updated: Aug 18, 2026
Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
Published on: January 11, 2019
Carpal tunnel syndrome in children
Paul M Lamberti1, Terry R Light
1Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA. paull56@prodigy.net
Insights
Carpal tunnel syndrome (CTS) is rare in children but can be caused by various conditions. Early diagnosis and bilateral electrodiagnostic studies are crucial for effective treatment, with open operative release being the only proven therapy.
Area of Science:
- Pediatric Neurology
- Orthopedic Surgery
- Nerve Conduction Studies
Background:
- Carpal tunnel syndrome (CTS) is infrequently diagnosed in pediatric populations.
- Genetic factors (lysosomal storage diseases, family history) and macrodactyly can predispose children to CTS.
- Idiopathic cases occur, even in healthy children, presenting diagnostic challenges.
Observation:
- Children with CTS often exhibit subtle, long-standing symptoms like reduced manual dexterity or vague pain.
- Clinical presentation can be misleading, with severe thenar weakness and atrophy mimicking primary thenar hypoplasia.
- Traditional provocative tests (Tinel, Phalen) are frequently negative in pediatric CTS cases.
Findings:
- Electrodiagnostic studies, including electromyography (EMG) and nerve conduction studies (NCS), are essential for accurate diagnosis.
- Pediatric CTS often presents with bilateral electrophysiologic abnormalities, irrespective of unilateral clinical involvement.
- Bilateral EMG and NCS are recommended for all suspected pediatric cases, with sedation potentially aiding small children.
Implications:
- Delayed diagnosis is common due to subtle symptoms and unreliable provocative tests.
- Profound atrophy in young patients can lead to misdiagnosis as congenital thenar hypoplasia.
- Open operative release is the sole established effective treatment for pediatric carpal tunnel syndrome.
Abstract:
CTS is uncommon in children. A number of conditions predispose children to developing CTS. These conditions include the lysosomal storage diseases, a multigenerational history of CTS, and macrodactyly. Because many case are idiopathic, isolated cases are possible even in the normal child or adolescent. Children with CTS often have modest complaints in spite of long-standing difficulties such as decreased manual dexterity in one hand or poorly localized pain. Physical findings tend to be dramatic abnormalities such as severe thenar weakness and atrophy. These findings suggest that many children are diagnosed late in the course of their nerve compression. Because some patients have profound atrophy at a young age, the condition can be confused with primary thenar hypoplasia. Provocative tests, the Tinel and Phalen tests, are often normal in children with long-standing nerve compression. Electrodiagnostic studies are essential to establishing the diagnosis in many children. Pediatric cases of CTS tend to demonstrate bilateral electrophysiologic abnormalities, even if only one hand is primarily involved clinically. Therefore, it is recommended that EMG and NCS be performed bilaterally in all suspected children. Sedation may be helpful in obtaining electrodiagnostic studies in a small child. Open operative release is the only treatment documented to be effective in the treatment of childhood CTS.
