Abstract
Carpal tunnel syndrome (CTS) is one of the commonest compression neuropathy. It carries significant employment and health care costs and causes much grief to patients. There are numerous causes for carpal tunnel syndrome; however, in this review, the authors concentrate on trauma as a primary etiology. CTS is essentially a compression of the median nerve within the carpal tunnel producing debilitating symptoms and signs. Early recognition of the clinical presentation of this syndrome is vital, since it is a surgical emergency and urgent release is indicated. The anatomy, etiology, pathogenesis, clinical features, investigations, and management with case presentation have been discussed in detail, referencing a diverse collection of textbooks and papers. A comprehensive literature review of 44 papers was performed, with compilation of current treatment guidelines and management. Picture illustrations of a case encountered by the authors are included for better understanding for clinicians and trainees. This article describes acute CTS in detail and provides information for correct and early diagnosis together with effective treatment. The risk factors and treatment options are discussed in detail with photographic illustrations, providing simple but comprehensive material for education of students and clinicians, therefore to improve outcome of patients with this potentially devastating condition.
This is a preview of subscription content, access via your institution.




References
Thatte MR, Mansukhani KA (2011) Compressive neuropathy in the upper limb. Indian J Plast Surg 44(2):283–297
American Academy of Neurology, Quality Standards Subcommittee (1993) Practise parameter for carpal tunnel syndrome. Neurology. 43:2406–2409
Paget J (1854) Lectures on surgical pathology, 2nd edn. Lindsay & Blakiston, Philadelphia, pp 42–43
Marie P, Foix C (1913) Atrophie isolee de l'eminence thenar d'origine nevritique. Role du ligament annulaire anterieur du carpe dans la pathogenie de la lesion. Rev Neurol (Paris) 26:647–649
Phalen GS (1966) The carpal tunnel syndrome: 17 years experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 48(2):211–228
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosin I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282(2):153–158
Sternbach G (1999) The carpal tunnel syndrome. J Emerg Med 17(3):519–523
Katz JN, Simmons BP (2002) Clinical Practice. Carpal tunnel syndrome. N Engl J Med 346(23):1807–1812
Tiong WH, Ismael TS, Regan PJ (2006) Fibroma of tendon sheath: a rare cause of carpal tunnel syndrome. J Hand Surg Br 31(5):579–580
Latinovic R, Gulliford MC, Hughes RA (2006) Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry 77(2):263–265
Bland JD, Rudolfer SM (2003) Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 74(12):1674–1679
Mondelli M, Giannini F, Giacchi M (2002) Carpal tunnel syndrome incidence in a general population. Neurology 58:289–294
Liss GM, Armstrong C, Kusiak RA, Gailitis MM (1992) Use of provincial health insurance plan billing data to estimate carpal tunnel syndrome morbidity and surgery rates. Am J Ind Med 22:395–409
Bacorn RW, Kurtzke JF (1953) Colles’ fracture study of two thousand cases from the New York State Workmen's Compensation Board. J Bone Joint Surg Am 35:643–658
Frykman G (1973) Fracture of the distal radius including sequelae-shoulder hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function: a clinical and experimental study. Acta Orthop Scand 108:1–155
Cooney WP, Dobyns JH, Linscheid RL (1980) Complications of Colles fractures. J Bone Joint Surg Am 62:613–619
Bienek T, Kusz D, Cielinski L (2007) Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg Eur Vol 32(2):233–234
Gelberman RH, Szabo RM, Williamson RV, Hargens AR, Yaru NC, Minteer-Convery MA (1983) Tissue pressure threshold for peripheral nerve viability. Clin Orthop Rel Res 178(09):285–291
Ames EL (1996) Carpal tunnel syndrome and motor vehicle accidents. J Am Osteopath Assoc 96(1):223
Weiland AJ, Lister GD, Villarreal-Rios A (1976) Volar fracture dislocations of the second and third carpometacarpal joints associated with acute carpal tunnel syndrome. J Trauma 16(8):672–675
Manske PR (1978) Fracture of the hook of the hamate presenting as carpal tunnel syndrome. J Hand Surg Eur 10(2):181–183
Mack GR, McPherson SA, Lutz RB (1994) Acute median neuropathy after wrist trauma. The role of emergent carpal tunnel release. Clin Orthop Relat Res 300:141–146
Turner RG, Faber KJ, Athwal GS (2007) Complications of distal radius fractures. Orthop Clin North Am 38(2):217–228
McKay SD, MacDermid JC, Roth JH, Richards RS (2001) Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am 26:916–922
Yu GX, Firrell JC, Tsai TM (1992) Preoperative factors treatment outcome following carpal tunnel release. J Hand Surg Br 17:1020–1023
Langloh ND, Linscheid RL (1972) Recurrent and unrelieved carpal-tunnel syndrome. Clin Orthop Rel Res 83(3):41–47
Cobb et al (1996) Outcome of reoperation for carpal tunnel syndrome. J Hand Surg 21:347–356
Bland J (2007) Clinical review: carpal tunnel syndrome. BMJ 335:343–346
Wright PE (2007) Chapter 73–Carpal tunnel, ulnar tunnel, and stenosing tenosynovitis. In: Canale & Beaty: Campbell's operative orthopaedics, 11th ed. Mosby: New York, pp 4285–4335
Tyson K, Cobb MD, Dalley BK, Posteraro RH, Lewis RC (1993) Anatomy of the flexor retinaculum. J Hand Surg 18(1):91–99
Singer G, Ashworth CR (2001) Anatomic variations and carpal tunnel syndrome: 10 year clinical experience. Clin Orthop Rel Res 392:330–340
Bienek T, Kusz D, Cielinski L (2006) Peripheral nerve compression neuropathy after fractures of the distal radius. J Hand Surg Eur 31(3):256–260
Figus A, Iwuagwu FC, Elliot D (2007) Subacute nerve compressions after trauma and surgery of the hand. Plast Reconstr Surg 120(3):705–712
McGrath MH, Polayes IM (1979) Posttraumatic median neuroma: a cause of carpal tunnel syndrome. Ann Plast Surg 3(3):227–230
Coert JH, Dellon AL (1994) Peripheral nerve entrapment caused by motor vehicle crashes. J Trauma 37(2):191–194
Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH (1981) The carpal tunnel syndrome: a study of carpal canal pressures. J Bone Joint Surg 63:380–383
Ettema AM, Amadio PC, Zhao C, Wold LE, An K-N (2004) A histological and biochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. J Bone Joint Surg 86:1458–1466
SW Wolfe, RN Hotchkiss, WC Pederson, SH Kozin (2010) Part V, Chapter 30 Compression of the median nerve. In. Green’s operative hand surgery. 6th ed Vol 1, Churchill Livingstone, New York
Bezerra AJ, Carvalho VC, Nucci A (1986) An anatomical study of the palmar cutaneous branch of the median nerve. Surg Radiol Anat 8:183–188
Gelberman RH, Rydevik BL Pess GM, Szabo RM and Lundburg G (1998) Carpal tunnel syndrome. Orthop Clin North Am. 115–124
Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. American Academy of Orthopaedic Surgeons. September 2008. Available at http://www.aaos.org/Research/guidelines/CTSTreatmentGuideline.pdf
Preston DC, Shapiro BE (1998) Median neuropathy in electromyography and neuromuscular disorders. Clinical-electrophysiologic correlations. Butterworth-Heinemann, Boston, p 231
Arcy CA, McGee S (2000) The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 283(23):3110
MacDermid JC, Wessel J (2004) Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther 17(2):309
MacDonald RI, Lichtman DM, Hanlon JJ, Wilson JN (1978) Complications of surgical release for carpal tunnel syndrome. J Hand Surg Am 3(1):70
Chang CW, Wang YC, Chang KF (2008) A practical electrophysiological guide for non-surgical and surgical treatment of carpal tunnel syndrome. J Hand Surg Eur 33:132–137
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jhattu, H., Klaassen, S., Ying, C. et al. Acute carpal tunnel syndrome in trauma. Eur J Plast Surg 35, 639–646 (2012). https://doi.org/10.1007/s00238-012-0732-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-012-0732-0
Keywords
- Acute
- Carpal tunnel syndrome
- Trauma
- Median nerve compression