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Updated: Mar 4, 2026

Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Surgical Management of Wrist Arthritis Is Linked to Increased Carpal Tunnel Syndrome/Carpal Tunnel Release Risk:
Majd Mzeihem1, Michael Foy1, John Alvarez1
1Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL.
Purpose:
This study aimed to determine whether patients with wrist arthritis undergoing corrective surgeries, such as 4-corner fusion (4CF), proximal row carpectomy (PRC), wrist fusion, or total wrist arthroplasty, have a higher incidence of carpal tunnel syndrome (CTS) and subsequent carpal tunnel release (CTR) compared with those managed nonsurgically.
Methods:
The PearlDiver database was used to identify two patient groups: the surgical group (patient with wrist arthritis who underwent corrective surgery) and the conservative group (patients with wrist arthritis who did not have surgery). Exclusion criteria included prior CTS or CTR. The surgical group was matched to the conservative and control groups based on age, gender, diabetes, hypothyroidism, and the Elixhauser Comorbidity Index. CTS and CTR incidence were analyzed using the chi-square test.
Results:
Of 2.5 million patients with wrist arthritis, those undergoing surgical intervention (n = 18,125) had significantly higher rates of CTS and CTR than the matched conservative cohort. At 1 year after surgery, 26.4% of surgical patients developed CTS versus 7.0% in the conservative group (OR, 4.06), with CTR rates of 17.7% versus 2.3% (OR, 8.25; P < .05). These elevated risks persisted up to 2 years and were highest within the first 6 months after surgery. Among surgical procedures, 4CF was associated with the highest incidence of CTS and CTR, though multivariate analysis revealed PRC had the greatest adjusted odds of both outcomes, respectively (OR, 3.33; OR, 6.04).
Conclusions:
Patients with wrist arthritis who undergo surgery face higher risks of CTS and subsequent CTR than those managed conservatively. Among procedures, 4CF showed the highest incidence, whereas PRC carried the highest adjusted odds after accounting for comorbidities. These findings emphasize the need to recognize carpal tunnel morphologic changes during surgery and support preoperative screening and potential prophylactic measures to reduce postoperative median nerve compression.
Type Of Study/Level Of Evidence:
Prognostic II.
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