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Carpal Tunnel Syndrome Follow-up

  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Robert H Meier, III, MD  more...
 
Updated: Jul 01, 2015
 

Further Outpatient Care

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  • Individuals treated conservatively for carpal tunnel syndrome should undergo a follow-up in 4-6 weeks so that the success of treatment interventions can be assessed. Patients who do not achieve the desired results from conservative treatment should be referred for a surgical opinion.
  • Continued symptoms following carpal tunnel release should prompt referral for repeat electrophysiologic studies.
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Deterrence

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  • No conclusive evidence exists of any intervention that can prevent carpal tunnel syndrome.
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Complications

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  • Carpal tunnel syndrome may continue to increase median nerve damage, leading to permanent impairment and disability.
  • Some individuals can develop chronic wrist and hand pain (with or without reflex sympathetic dystrophy).
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Prognosis

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  • Carpal tunnel syndrome (CTS) appears to be progressive over time (although with considerable fluctuations from week to week) and can lead to permanent median nerve damage. Whether any conservative management can prevent progression is unclear. Even with surgical release, it appears that the syndrome recurs to some degree in a significant number of cases (possibly in up to one third after 5 years).[31]
  • Initially, approximately 90% of mild to moderate CTS cases respond to conservative management. Over time, however, a number of patients progress to requiring surgery.
  • Patients with CTS secondary to underlying pathology (eg, diabetes, wrist fracture) tend to have a less favorable prognosis than do those with no apparent underlying cause.
  • Patients with normal electrophysiologic studies consistently have much less favorable operative outcomes (and more complications) than do individuals with abnormalities on these tests. Axonal loss on electrophysiologic testing also indicates a less favorable prognosis.
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Patient Education

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  • Association versus cause - The association of 2 phenomena does not imply a causal relationship. Using the hands frequently brings on symptoms of carpal tunnel syndrome (CTS), in the same way that exercise brings on angina in patients with coronary artery disease. This association, however, does not necessarily mean that the median nerve damage is caused by use or that it will get worse. (Exercise, in fact, is good for coronary artery disease.)
  • Avoidance of extremes - If a patient's vocation/avocation involves extreme force/repetition/posture/vibration through the wrist, then it seems prudent to seek ways of avoiding factors that cause or aggravate CTS.
  • Exercise - BMI and poor fitness levels do appear to be related to the development of CTS.

For patient education resources, see Carpal Tunnel Net, or the Hand, Wrist, Elbow, and Shoulder Center and Arthritis Center, as well as Carpal Tunnel Syndrome.

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Contributor Information and Disclosures
Author

Nigel L Ashworth, MBChB, MSc, FRCPC Professor, Divisions of Physical Medicine and Rehabilitation and Neurology, University of Alberta Faculty of Medicine and Dentistry, Canada

Nigel L Ashworth, MBChB, MSc, FRCPC is a member of the following medical societies: Canadian Society of Clinical Neurophysiologists, Australian & New Zealand Association of Neurologists, American Association of Neuromuscular and Electrodiagnostic Medicine, British Medical Association, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Benjamin M Sucher, DO, FAOCPMR, FAAPMR Medical Director, EMG Labs of AARA (Arizona Arthritis and Rheumatology Associates)

Benjamin M Sucher, DO, FAOCPMR, FAAPMR is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic College of Physical Medicine and Rehabilitation, Arizona Society of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

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The hands of an 80-year-old woman with a several-year history of numbness and weakness are shown in this photo. Note severe thenar muscle (abductor pollicis brevis, opponens pollicis) wasting of the right hand, with preservation of hypothenar eminence.
Sensory nerve conduction studies from the left hand of a patient with a several-year history of numbness and weakness (responses from the median nerve in the right hand were completely absent). Note marked slowing of the conduction velocity (CV) to 29.8 and 25.5 m/s for digits 3 and 1, respectively (normal >50 m/s). The amplitude for both also is reduced markedly (normal >10). These findings are consistent with carpal tunnel syndrome.
Motor nerve conduction studies from the left hand of a patient with a several-year history of numbness and weakness (responses from the median nerve in the right hand were completely absent). Note that the conduction velocity (CV) across the carpal tunnel segment slows severely to 18.3 m/s (normal >50 m/s) and that the distal motor latency is prolonged at 6.3 ms (normal < 4.2 ms). Amplitudes are low for the wrist and elbow stimulus sites at 4.7 mV (normal >5 mV), but amplitudes are 31% higher distal to the carpal tunnel (at the palm). This discrepancy may represent conduction block (neurapraxia) at the level of the carpal tunnel or coactivation of the ulnar branch to adductor pollicis. Needle electromyography is required to determine whether axonal loss is present.
 
 
 
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