Carpal tunnel syndrome in chronic renal dialysis patients

Pain, dysesthesias, sensory changes, and weakness in hands of uremic patients receiving renal dialysis are usually attributed to peripheral neuropathy or vascular steal syndrome. Our experience suggested superimposed carpal tunnel syndrome (CTS) as an additional etiology. This premise was studied by using electromyography and standardized electrodiagnostic techniques to measure median and ulnar conduction velocities and distal motor and sensory latencies. Of 48 patients tested, 15 (31%) had symptomatic CTS, confirmed by electrodiagnosis. Seven of these patients had bilateral CTS. Twelve patients subsequently had surgical flexor retinaculum release, resulting in relief of symptoms. Thirty-seven of the 48 patients tested, including all 15 with CTS, had peripheral neuropathy. Of the patients with peripheral neuropathy, and who were on dialysis longer than 5 years, 57% also had CTS. Slowing of ulnar nerve conduction velocity across the elbow was found in 11 arms, including 3 with CTS. The high incidence of CTS in this renal dialysis population appears to be related to nerve compression secondary to a thickened transverse carpal ligament. Increasing time on dialysis was related to an increased incidence of CTS. However, the presence of forearm access (AV fistula or cannula) was not crucial to the development of CTS. CTS is treatable and should be considered in the differential diagnosis of hand and arm symptoms in chronic dialysis patients.