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Updated: Dec 2, 2025
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Outcomes of Pediatric and Adolescent Carpal Tunnel Release
Katherine Velicki1, Charles A Goldfarb1, Summer Roberts1
1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
Insights
Carpal tunnel release (CTR) offers temporary relief for children with lysosomal storage disease, while acute traumatic cases see full symptom resolution. Idiopathic and delayed traumatic carpal tunnel syndrome (CTS) often result in recurrent or persistent symptoms post-surgery.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Neurology
Background:
- Carpal tunnel syndrome (CTS) can affect pediatric and adolescent populations.
- Understanding the varied etiologies and long-term outcomes of carpal tunnel release (CTR) in this demographic is crucial for effective management.
Purpose of the Study:
- To investigate the clinical presentation of carpal tunnel syndrome in children and adolescents.
- To evaluate the long-term outcomes following carpal tunnel release surgery in pediatric and adolescent patients.
Main Methods:
- A retrospective review of pediatric and adolescent patients who underwent CTR between 2003 and 2018.
- Patients were categorized by etiology: lysosomal storage disease, idiopathic, acute traumatic, delayed traumatic, and tumorous.
- Outcomes were assessed using phone interviews, chart review, Boston Carpal Tunnel Questionnaire (BCTQ), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
Main Results:
- Of 25 patients (31 hands), 18 completed long-term follow-up (median 4.7 years).
- Lysosomal storage disease cases showed initial relief but eventual symptom recurrence in all evaluated.
- Acute traumatic and tumorous etiologies generally had full symptom resolution, while delayed traumatic and idiopathic cases frequently experienced recurrent or recalcitrant symptoms.
Conclusions:
- Carpal tunnel release can provide years of symptom relief for pediatric patients with lysosomal storage disease.
- CTR is effective for acute traumatic CTS but less so for delayed traumatic or idiopathic cases, which often present with persistent or recurring symptoms.
Purpose:
To investigate carpal tunnel syndrome (CTS) presentation and long-term outcomes of carpal tunnel release (CTR) in children and adolescents.
Methods:
All pediatric and adolescent patients who underwent CTR between February 2003 and June 2018 were identified. Patients were grouped by etiology: lysosomal storage disease (11 hands), idiopathic (6 hands), acute traumatic (7 hands), delayed traumatic (5 hands) and tumorous (2 hands). Medical records were reviewed for presenting symptoms and preoperative treatments. Final outcomes were assessed via phone interviews, chart review, the Boston Carpal Tunnel Questionnaire (BCTQ), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
Results:
All 25 patients (31 hands) identified were included in the study; median age at surgery was 12.7 years (range, 2.5-23.3 years). Eighteen patients completed surveys at a median of 4.7 years after surgery (range, 8 months-16 years). Common presenting symptoms in lysosomal storage disease were numbness/tingling (7 hands); pain was only reported in 1 hand. The most frequent indication for acute traumatic CTR (7 hands) was palmar hand swelling at the carpal tunnel (4 hands). Delayed traumatic and idiopathic CTS most often presented with numbness/tingling (4 hands and 6 hands, respectively) and pain (3 hands, 4 hands, respectively). Of the original 4 lysosomal storage disease surgeries included in long-term follow-up, all experienced gradual recurrence of symptoms after years of relief (range, 3-14 years). Two patients underwent revision CTR and were symptom-free at follow-up. All patients with acute traumatic and tumorous etiologies had full resolution of symptoms. Delayed traumatic and idiopathic etiologies frequently experienced recurrent or recalcitrant symptoms (4 of 5 and 3 of 6 surgeries, respectively).
Conclusions:
Carpal tunnel release often alleviates symptoms in children with lysosomal storage disease for years to decades. Carpal tunnel release successfully relieves symptoms in acute traumatic cases, but is not always sufficient to relieve symptoms associated with delayed traumatic etiologies. Approximately half of patients with idiopathic CTS experience recalcitrant or recurrent symptoms.
Type Of Study/Level Of Evidence:
Therapeutic IV.
