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Published on: January 11, 2019
Post-traumatic carpal tunnel syndrome in children
Julianna Lee1, Eliza Buttrick1, Apurva S Shah1
1Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Acute carpal tunnel syndrome (CTS) in children often follows distal radius fractures. Urgent surgical release is recommended for acute CTS to ensure faster recovery and positive outcomes.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Neurology
Background:
- Limited data exists on acute carpal tunnel syndrome (CTS) in pediatric populations.
- Post-traumatic CTS in children is often associated with wrist or forearm injuries.
- Distal radius fractures are a common cause of post-traumatic CTS in this age group.
Purpose of the Study:
- To describe the clinical presentation of post-traumatic CTS in children.
- To evaluate the treatment outcomes for pediatric patients with post-traumatic CTS.
- To provide insights into the management of acute versus delayed presentations of CTS following trauma.
Main Methods:
- Retrospective single-center cohort study.
- Inclusion of pediatric patients diagnosed with post-traumatic CTS.
- Data collection on demographics, clinical presentation, treatment, and outcomes via electronic medical records.
Main Results:
- 18 pediatric patients (16 male, mean age 12.8 years) with post-traumatic CTS were identified.
- 83% of injuries involved distal radius fractures; 13 patients presented acutely (<3 days).
- 81% of surgically treated patients achieved complete symptom relief; acute CTS requires urgent release to avoid prolonged recovery.
Conclusions:
- Post-traumatic CTS in children frequently presents acutely following distal radius fractures.
- Urgent carpal tunnel release is crucial for acute CTS to prevent prolonged recovery.
- Operative treatment generally yields positive outcomes for pediatric post-traumatic CTS.
Background:
Given limited information about acute carpal tunnel syndrome (CTS) in children, the purpose of this study is to describe the presentation and treatment results of CTS after traumatic wrist or forearm injury in a pediatric population.
Methods:
In this retrospective single-center cohort study, all children with post-traumatic CTS were identified. Demographic and clinical presentation, treatment, and outcomes data were collected from the electronic medical record. Descriptive statistics were calculated for variables of interest, and Χ2 and independent sample t-tests were used for subgroup comparisons.
Results:
18 patients (16 male, average age 12.8 ± 3.6 years) with post-traumatic CTS were identified. 13 presented acutely (<3 days) versus 4 subacutely (1-6 weeks) and one delayed presentation (>6 weeks) after injury. Of associated traumas, 83% (15/18) involved distal radius fractures, of which 40% (6/15) had an associated ulna fracture. The most common symptoms were numbness (78%), paresthesias (33%), and increasing pain (28%). Three patients had clinical concerns for concomitant compartment syndrome. 6 patients were initially monitored (2 acute, 3 subacute, 1 delayed). Ultimately, 16/18 underwent operative release (13/13 acute, 2/4 subacute, 1/1 delayed). At follow-up, 81% of the surgically treated patients had complete symptomatic relief. There was no statistically significant difference in treatment outcomes between acute versus subacute or delayed presentation (OR: 6.67, p = .214). Of patients with acute CTS, delayed surgery resulted in prolonged recovery (28.0 vs. 2.4 weeks, p < .001).
Conclusions:
Post-traumatic CTS more often presents acutely than as a delayed complication of distal radius fractures in children. The type of injury and clinical presentation can vary, but patients most often present with median neuropathy symptoms like numbness. Acute CTS should be treated urgently with carpal tunnel release. While patients with delayed presentation can trial observation, the patient will likely warrant surgery for complete symptom relief. Operative treatment for both acute and subacute cases generally results in positive outcomes.
Key Concepts:
(1)Post-traumatic CTS may present acutely as a complication of distal radius fractures in children with symptoms of numbness, paresthesias, and increasing pain.(2)Acute CTS should be treated with urgent carpal tunnel release to avoid prolonged recovery.(3)Children with delayed presentation of CTS can be safely monitored, but the patient often needs surgery to experience complete symptom relief.(4)Operative treatment for post-traumatic CTS in children generally results in positive outcomes.
Level Of Evidence:
IV Case Series.
