Carpal Tunnel Syndrome Follow-up

  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Nov 3, 2011
 

Further Outpatient Care

  • 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

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

  • 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

  • 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).[24]
  • 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

  • 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.
  • Reduction of caffeine, alcohol, and/or nicotine intake - All of these substances are associated with the development of CTS.
  • Exercise - BMI and poor fitness levels do appear to be related to the development of CTS.

For patient education resources, see 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 and Chief, Division of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, University of Alberta

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

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

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

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 and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References

  1. de Krom MC, Kester AD, Knipschild PG, et al. Risk factors for carpal tunnel syndrome. Am J Epidemiol. Dec 1990;132(6):1102-10. [Medline].

  2. Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. Jul 14 1999;282(2):153-8. [Medline]. [Full Text].

  3. de Krom MC, Knipschild PG, Kester AD, et al. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. Apr 1992;45(4):373-6. [Medline].

  4. Goga IE. Carpal tunnel syndrome in black South Africans. J Hand Surg [Br]. Feb 1990;15(1):96-9. [Medline].

  5. Garland FC, Garland CF, Doyle EJ Jr, et al. Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel. Arch Environ Health. Sep-Oct 1996;51(5):395-407. [Medline].

  6. Durkan JA. The carpal-compression test. An instrumented device for diagnosing carpal tunnel syndrome. Orthop Rev. Jun 1994;23(6):522-5. [Medline].

  7. Kao SY. Carpal tunnel syndrome as an occupational disease. J Am Board Fam Pract. Nov-Dec 2003;16(6):533-42. [Medline]. [Full Text].

  8. Palmer KT, Harris EC, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond). Jan 2007;57(1):57-66. [Medline].

  9. Bernard PB, ed. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. Cincinnati, Ohio: National Institute for Occupational Safety and Health; Jul 1997. [Full Text].

  10. Zagnoli F, Andre V, Le Dreff P, et al. Idiopathic carpal tunnel syndrome. Clinical, electrodiagnostic, and magnetic resonance imaging correlations. Rev Rhum Engl Ed. Apr 1999;66(4):192-200. [Medline].

  11. Lee D, van Holsbeeck MT, Janevski PK, et al. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiol Clin North Am. Jul 1999;37(4):859-72, x. [Medline].

  12. Robinson LR. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am. Nov 2007;18(4):733-46, vi. [Medline].

  13. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Muscle Nerve. Dec 1993;16(12):1390-1. [Medline].

  14. Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve. Dec 1997;20(12):1477-86. [Medline].

  15. Chang MH, Lee YC, Hsieh PF. The real role of forearm mixed nerve conduction velocity in the assessment of proximal forearm conduction slowing in carpal tunnel syndrome. J Clin Neurophysiol. Nov 6 2008;[Medline].

  16. Banta CA. A prospective, nonrandomized study of iontophoresis, wrist splinting, and antiinflammatory medication in the treatment of early-mild carpal tunnel syndrome. J Occup Med. Feb 1994;36(2):166-8. [Medline].

  17. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;CD003219. [Medline].

  18. Verhagen AP, Karels C, Bierma-Zeinstra SM, et al. Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. A Cochrane systematic review. Eura Medicophys. Sep 2007;43(3):391-405. [Medline].

  19. Ugurlu U, Ozkan M, Ozdogan H. The development of a new orthosis (neuro-orthosis) for patients with carpal tunnel syndrome: its effect on the function and strength of the hand. Prosthet Orthot Int. Dec 2008;32(4):403-21. [Medline].

  20. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554. [Medline].

  21. Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med. May-Jun 2004;2(3):267-73. [Medline]. [Full Text].

  22. Meys V, Thissen S, Rozeman S, Beekman R. Prognostic factors in carpal tunnel syndrome treated with a corticosteroid injection. Muscle Nerve. Nov 2011;44(5):763-8. [Medline].

  23. [Best Evidence] Scholten RJ, Mink van der Molen A, Uitdehaag BM, et al. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(4):CD003905. [Medline].

  24. Boya H, Ozcan O, Oztekin HH. Long-term complications of open carpal tunnel release. Muscle Nerve. Nov 2008;38(5):1443-6. [Medline].

  25. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. Oct 8 2008;CD001552. [Medline].

  26. Dumitru D. Focal peripheral neuropathies. In: Dumitru D, ed. Electrodiagnostic Medicine. San Antonio, Tex: University of Texas Press; 1995:867-75.

  27. Johnson EW, ed. Carpal tunnel syndrome. In: Physical Medicine and Rehabilitation Clinics of North America. vol 8. Philadelphia, Pa: WB Saunders; 1997:3.

  28. Nathan PA, Keniston RC. Carpal tunnel syndrome. In: Kasdan ML, ed. Occupational Hand and Upper Extremity Injuries and Diseases. St Louis, Mo: Mosby-Year Book; 1991:129-39.

  29. Nordstrom DL, DeStefano F, Vierkant RA, et al. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology. May 1998;9(3):342-5. [Medline].

  30. Nordstrom DL, Vierkant RA, DeStefano F, et al. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med. Oct 1997;54(10):734-40. [Medline]. [Full Text].

  31. Rempel D, Evanoff B, Amadio PC, et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health. Oct 1998;88(10):1447-51. [Medline]. [Full Text].

  32. Rotman MB, Enkvetchakul BV, Megerian JT, et al. Time course and predictors of median nerve conduction after carpal tunnel release. J Hand Surg [Am]. May 2004;29(3):367-72. [Medline].

  33. Stevens JC, Sun S, Beard CM, et al. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. Jan 1988;38(1):134-8. [Medline].

  34. Stewart JD. Compression and entrapment neuropathies. In: Dyck PJ, Thomas PK, eds. Peripheral Neuropathy. 3rd ed. Philadelphia, Pa: WB Saunders; 1993:961-79.

  35. Sucher BM. Palpatory diagnosis and manipulative management of carpal tunnel syndrome. J Am Osteopath Assoc. Aug 1994;94(8):647-63. [Medline]. [Full Text].

  36. Sucher BM, Glassman JH. Upper extremity syndromes. In: Stanton D, Mein E, eds. Manual Medicine. vol 7. Philadelphia, Pa: WB Saunders; 1996:787-810.

  37. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. Aug 18 1973;2(7825):359-62. [Medline].

 
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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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