Effectiveness of transfer carpal tunnel ligament transection in patients with the CRPS-like symptoms/irritable carpal tunnel syndrome following upper limb trauma: A case series

Abstract

Complex regional pain syndrome (CRPS) is a diagnosis we are often confronted with as upper limb surgeons. It is found in 1 to 37 % of distal radius fractures. Recovery times are long, and treatment is often only partially effective in the majority of patients. It therefore seems essential to consider an alternative diagnosis in order to help these patients. As shown by Prof Del Pinal's study, Outcomes of Carpal Tunnel Release in Complex Regional Pain Syndrome, the existence of irritative carpal tunnel syndrome in his patients, and its management by carpal tunnel release, seems to be in line, both clinically and therapeutically, with the patients’ complaints.

In this retrospective study, we included 25 patients. The patients had previously been diagnosed with complex regional pain syndrome, following trauma to the upper limb, or presented with pain disproportionate to the initial trauma, and on an ongoing basis. We included patients with exclusively unilateral pain. A negative median nerve electromyogram did not present a contraindication to opening the transverse ligament at the carpal tunnel.

We assessed the results of surgical management of these patients using the visual analogue scale (VAS). The mean reduction in VAS score was 45 %, with a minimum delay of 2 months between the pre- and postoperative scores. The effect on the QuickDASH score before and after the operation was favourable, with an average reduction of 23 points. Of the 25 patients, we lost sight of 3 patients, and 2 patients refused to be included in the study.

Carpal tunnel decompression is a promising surgical procedure for patients presenting with acute hand pain following upper extremity trauma, despite the absence of further investigations suggesting carpal tunnel compression. The early post-operative follow-up, less than 1 month, shows an improvement in mobility in the majority of patients. This approach can offer significant symptomatic relief and functional improvement in these patients. This treatment option should be considered for patients diagnosed with complex regional syndrome. Delay in diagnosis and management can potentially influence outcome. Early diagnosis is the guarantee of a quicker and painless recovery, avoiding a potentially heavy rehabilitation programme without full recovery.