Post-burn carpal tunnel syndrome: A systematic review.

Abstract

Objectives: Post-burn neuropathy is a little-known pathology. However, the nerve is the most sensitive organ to burns, especially electrical burns. Carpal tunnel syndrome is the most common mononeuropathy worldwide and the most common post-burn neuropathy. The aim of this study is to evaluate, through a review of the literature, the specificities of the management of mononeuropathy of the median nerve at the wrist occurring at a distance from the burn injury.

Methods: A comprehensive search of the literature was conducted using the Cochrane Library, PubMed, and EMBASE. We included all articles that mentioned nerve injury associated with burns and excluded those that did not address the median nerve or in which the median nerve was the subject of early release. For each study, we compared diagnostic methods and patient management elements. We propose to associate to this review the case of a 23-year-old male victim of an electrical burn who developed a carpal tunnel at a distance from his burn. The patient underwent surgery and was evaluated 1 mo and 6 mo after surgery using grip strength, Weber's two-point discrimination test, QuickDASH, and BCTSQ questionnaires. An electromyogram was performed preoperatively and 6 mo postoperatively.

Results: Thirteen articles met the inclusion criteria and were reviewed. The majority of these involved electrical and thermal burns, with TBSA ranging from 2% to 65%. The affected population was young (36.7 years) and predominantly male. The mean hospital stay was 59.1 days, compared with 137.5 days for diagnosis delay. Diagnostic electromyography was not always performed. No study used ultrasound or MRI to look for an etiology other than burns in the development of carpal tunnel syndrome. All studies that reported symptom improvement after treatment did not use a functional score. In our case, grip strength on the operated side improved moderately. Discriminative sensation was restored. QuickDASH and BCTSQ scores were initially poor and improved very modestly after surgery. Electromyography showed recovery of sensory conduction but no recovery of motor conduction.

Conclusion: Carpal tunnel syndrome can have significant functional consequences in burn patients because it is often overlooked and treated late. Early clinical and electromyographic diagnosis is essential to ensure surgical management before irreversible intra-neural injury occurs. Ultrasound could be useful for the early detection of signs of median nerve injury at the wrist when electromyography is not possible, and to verify the absence of another associated etiology in the development of carpal tunnel syndrome after burns. We propose a decision algorithm for the management of carpal tunnel syndrome associated with burns.

Level of evidence: IV.