Skip to main content


Log in

Differential onset patterns and causes of carpal tunnel syndrome after distal radius fracture: a retrospective study of 105 wrists

  • Original Article
  • Published:
Journal of Orthopaedic Science



It is well known that carpal tunnel syndrome (CTS) can occur in a wide range of time periods after distal radius fracture (DRF). Few studies have evaluated in detail the relationship between fracture and electrophysiological finding characteristics and time to onset of CTS after DRF. To clarify the characteristics of CTS after DRF, we classified a large number of clinical cases based on the period from the injury to onset of CTS. These cases were analyzed retrospectively.


We reviewed 105 wrists with CTS following DRF. Patients’ ages ranged from 13 to 89 years. These 105 wrists were divided into three groups according to the period of post-fracture onset of CTS. Twenty-eight wrists were classified into the acute onset group (when the symptoms of CTS occurred within 1 week after fracture). Forty-seven wrists were classified into the subacute onset group (when symptoms of CTS occurred from 1 to 12 weeks after fracture). The remaining 30 wrists were classified into the delayed onset group (when symptoms of CTS occurred more than 12 weeks after fracture). Deformity of the distal radius on X-ray films was evaluated and distal motor latency (DML) of the median nerve was recorded to compare values among these three groups.


In the acute onset group, 68% had an AO C-type fracture and 46% were caused by a high-energy injury. The percentage of this fracture pattern and mechanism was significantly higher in the acute onset group than in the other groups (P < 0.05; Kruskal-Wallis test). In the subacute onset and delayed onset groups, 79% and 63% had an A-type fracture and more than 90% were caused by a low-energy injury. In the delayed onset group, the incidence of prolonged DML in the contralateral wrists was 71%, which was significantly higher than in the other two onset groups (P < 0.05; Kruskal- Wallis test).


There were three onset patterns of CTS after DRF, and each CTS onset pattern had different etiologic mechanisms and different clinical features of CTS. In the acute onset group, a high-energy fracture pattern was associated with CTS. In the subacute and the delayed onset groups, lowenergy injury in elderly women was associated with CTS. Both deformity of the fracture and preexisting median nerve dysfunction were suggested as predisposing factor for CTS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Pool C. Colles’ fracture. A prospective study of treatment. J Bone Joint Surg Br 1973;55-B:540–544.

    Google Scholar 

  2. Cooney WP, Dobyns JH, Linscheid RL. Complications of Colles’ fractures. J Bone Joint Surg Am 1980;62-A:613–619.

    Google Scholar 

  3. Lynch AC, Lipscomb PR. The carpal tunnel syndrome and Colles’ fractures. JAMA 1963;185:363–366.

    CAS  PubMed  Google Scholar 

  4. Aro H, Koivunen T, Katevuo K, Niemien S, Aho AJ. Late compression neuropathies after Colles’ fractures. Clin Orthop Relat Res 1988;233:217–225.

    PubMed  Google Scholar 

  5. Stewart HD, Innes AR, Burke FD. The hand complications of Colles’ fractures. J Hand Surg Br 1985;10:103–106.

    Article  CAS  PubMed  Google Scholar 

  6. Taniguchi Y. Carpal tunnel syndrome following Colles’ fracture. Cent Jpn Orthop Traumatol 1995;38:721–722 (in Japanese).

    Google Scholar 

  7. Lewis MH. Median nerve decompression after Colles’s fracture. J Bone Joint Surg Br 1978;60-B:195–196.

    CAS  PubMed  Google Scholar 

  8. Phalen GS. Spontaneous compression of median nerve at wrist. J Am Med. Assoc 1951;145:1128–1133.

    CAS  Google Scholar 

  9. Frykman G. Fractures of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radioulnar joint and impairment of nerve function. Acta Orthop Scand 1967; Suppl 108:1–153.

    Google Scholar 

  10. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res 1986;206:202–210.

    PubMed  Google Scholar 

  11. Fernandez DL, Palmer AK. Fractures of the distal radius. In: Green DP, Hotchikiss RN, Pederson WC, editors. Green’s operative hand surgery. Pennsylvania: Churchill Livingstone 1999; 929–985.

    Google Scholar 

  12. Kongsholm J, Olerud C. Carpal tunnel pressure in the acute phase after Colles’ fracture. Arch Orthop Trauma Surg 1986;105:183–186.

    Article  CAS  PubMed  Google Scholar 

  13. Sponsel KH, Palm ET. Carpal tunnel syndrome following Colles’ fracture. Surg Gynecol Obstet 1965;121:1252–1256

    CAS  PubMed  Google Scholar 

  14. Gelberman RH, Szabo RM, Mortensen WW. Carpal tunnel pressure and wrist flexion position in patients with Colles’ fractures. J Trauma 1984;24:747–748.

    Article  CAS  PubMed  Google Scholar 

  15. McCarrol HR. Nerve injuries associated with trauma. Orthop Clin North Am 1984;15:279–287.

    Google Scholar 

  16. Zachary RB. Thenar palsy due to compression of the median nerve in the carpal tunnel. Surg Gynecol Obstet 1945;81:213–221.

    Google Scholar 

  17. Shinoda J, Hashizume H, McCown C, Senda M, Nishida K, Doi T, Inoue H. Carpal tunnel syndrome grading system in rheumatoid arthritis. J Orthop Sci 2002;7:188–193.

    Article  PubMed  Google Scholar 

  18. Murga L, Moreno JM, Menendez C, Castilla JM. The carpal tunnel syndrome. Relationship between median distal motor latency and graded results of needle electromyography. Electromyogr. Clin Neurophysiol 1994;34:377–384.

    CAS  Google Scholar 

  19. Nakamichi K, Tachibana S. Unilateral carpal tunnel syndrome and space-occupying lesions. J Hand Surg Br 1993;18:748–749.

    Article  CAS  PubMed  Google Scholar 

  20. Taleisnik J, Watson HK. Midcarpal instability caused by malunited fractures of the distal radius. J Hand Surg Am 1984;9:350–357.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


About this article

Cite this article

Itsubo, T., Hayashi, M., Uchiyama, S. et al. Differential onset patterns and causes of carpal tunnel syndrome after distal radius fracture: a retrospective study of 105 wrists. J Orthop Sci 15, 518–523 (2010).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: