Related Experiment Videos
Carpal tunnel syndrome in childhood: study of 6 cases
1Electromyography Unit, Hospital La Luz, Madrid, Spain.
Insights
Carpal tunnel syndrome (CTS) in children has varied causes, including sports and genetic conditions. Nerve conduction studies are crucial for diagnosing pediatric CTS and monitoring recovery.
Area of Science:
- Pediatric Neurology
- Orthopedic Surgery
- Clinical Electrophysiology
Background:
- Carpal tunnel syndrome (CTS) is less common in children than adults, with diverse underlying etiologies.
- Understanding the causes and diagnostic approaches for pediatric CTS is essential for effective management.
Observation:
- This report details six pediatric cases of CTS (ages 5-14) with distinct causes: intensive basketball, Schwartz-Jampel syndrome, mucopolysaccharidosis I, autosomal dominant conditions, and hereditary neuropathy with liability to pressure palsies (HNPP).
- One patient with mucopolysaccharidosis I showed significant improvement after surgery.
- A 5-year-old presented with early bilateral CTS as the initial sign of HNPP, with affected relatives showing subclinical evidence.
Findings:
- Median nerve entrapment in children can stem from acquired factors like sports or congenital/genetic disorders.
- Nerve conduction studies (NCS) are diagnostic for pediatric CTS and aid in evaluating post-surgical outcomes.
- NCS in affected individuals and their relatives can reveal familial neuropathies.
Implications:
- Early diagnosis and appropriate management of pediatric CTS are vital for preventing long-term nerve damage.
- Genetic counseling and screening may be indicated for families with suspected hereditary neuropathies presenting as CTS.
- Nerve conduction studies play a critical role in the comprehensive assessment and management of pediatric carpal tunnel syndrome.
Abstract:
Six children, 4 girls and two boys, aged 5-14 years, with carpal tunnel syndrome (CTS) are reported. Median nerve entrapment had different aetiologies in each case. One patient developed unilateral CTS symptoms after intensive basketball training. He improved upon terminating this sporting activity. In 3 patients bilateral CTS was associated with Schwartz-Jampel syndrome, trigger finger and mucopolysaccharidosis I (MPS IS = Scheie syndrome), respectively. The latter subject, a boy aged 11 years who had severe bilateral muscle thenar weakness and atrophy, made a good recovery after surgery. Two cases with bilateral CTS had autosomal dominant disease. One of them showed familial CTS with thickening of the transverse carpal ligament. The other child (5 years old) presented early bilateral CTS as first manifestation of hereditary neuropathy with liability to pressure palsies (HNPP). His relatives were asymptomatic, but they showed electrophysiological and nerve biopsy changes consistent with HNPP. Nerve conduction studies (NCS) are diagnostic in paediatric CTS. Moreover, NCS is an objective method to evaluate the evolution of the nerve lesions after surgery. NCS must be performed in nerves of the propositus other than the median, as well as in first degree symptomatic and asymptomatic relatives in order to identify possible familial neuropathies.