Carpal Tunnel Syndrome Follow-up

Updated: Feb 27, 2018
  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA  more...
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Follow-up

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). [18]

  • 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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