Short-Term Outcomes of Carpal Tunnel Release in Patients with CRPS-Like Symptoms

Abstract

ABSTRACT Introduction Some patients diagnosed with complex regional pain syndrome (CRPS) may have an underlying peripheral nerve trigger, including mechanical irritation of the median nerve within the carpal tunnel. This study evaluated the short-term outcomes of carpal tunnel release in adults with persistent CRPS-like symptoms and suspected irritative carpal tunnel syndrome. Methods This retrospective case series included adult patients who underwent mini-open carpal tunnel release after failing at least three months of medical treatment and hand therapy. Patients were assessed preoperatively and six weeks postoperatively using the visual analog scale (VAS), Patient-Specific Functional Scale (PSFS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, grip strength, and tripod pinch strength. Preoperative and postoperative values were compared using the two-sided exact Wilcoxon signed-rank test. Results There were eight patients with a mean age of 55 ± 13.2 years. The median VAS score decreased from 8 to 0, the median PSFS score increased from 2.9 to 8.1, and the median DASH score decreased from 64.5 to 16.5 at six weeks postoperatively (p = 0.008 for all comparisons). Median grip strength increased from 8.3 to 10.2 kg, and median tripod pinch strength increased from 2.9 to 3.7 kg. Conclusions Carpal tunnel release was associated with significant short-term improvements in pain and patient-reported hand function in selected adults with persistent CRPS-like symptoms and suspected irritative carpal tunnel syndrome. Median nerve irritation should be considered as a potentially treatable peripheral contributor in patients who do not improve with conventional CRPS treatment. Larger prospective studies with longer follow-up are needed. Keywords: complex regional pain syndrome; irritative carpal tunnel syndrome; carpal tunnel release; median nerve; neuropathic pain

Keywords

• Carpal Tunnel Release
• irritative carpal tunnel syndrome
• Complex regional pain syndrome (CRPS)
• neuropathic pain
• median nerve

KBAS benzeri semptomları olan hastalarda karpal tünel gevşetme ameliyatının erken dönem sonuçları

Abstract

ÖZET Giriş Kompleks bölgesel ağrı sendromu (KBAS) tanısı konmuş bazı hastalarda, bu semptomların (karpal tünel içindeki median sinirin mekanik irritasyonu gibi) altta yatan bir periferik sinir tetikleyicisi olabilir. Bu çalışmada, kalıcı CRPS benzeri semptomları olan ve irritatif karpal tünel sendromundan şüphelenilen yetişkinlerde karpal tünel gevşetme ameliyatının erken dönem sonuçlarını değerlendirildi. Yöntemler Bu retrospektif vaka serisi, en az üç ay süren tıbbi tedavi ve el terapisinden fayda görmeyen ve mini-açık karpal tünel gevşetme ameliyatı geçiren yetişkin hastaları içermektedir. Hastalar ameliyat öncesi ve ameliyat sonrası altıncı haftada görsel analog skala (VAS), Hastaya Özgü Fonksiyonel skala (PSFS), Kol, Omuz ve El Engellilikleri (DASH) anketi, kavrama gücü ve üç parmak pinç gücü değerlerine bakılarak değerlendirildi. Ameliyat öncesi ve sonrası değerler, two-sided exact Wilcoxon signed-rank test kullanılarak karşılaştırıldı. Sonuçlar Ortalama yaş 55 ± 13,2 yıl olan sekiz hasta değerlendirildi. Ameliyat sonrası altı haftada ortalama VAS skoru 8'den 0'a düştü, ortalama PSFS skoru 2,9'dan 8,1'e yükseldi ve ortalama DASH skoru 64,5'ten 16,5'e düştü (tüm karşılaştırmalar için p = 0,008). Ortalama kavrama gücü 8,3 kg'dan 10,2 kg'a, ortalama üç parmak pinç gücü ise 2,9 kg'dan 3,7 kg'a yükseldi. Sonuç ve Öneriler Karpal tünel gevşetme ameliyatı, inatçı KBAS benzeri semptomları olan ve irritatif karpal tünel sendromundan şüphelenilen seçilmiş yetişkinlerde ağrı ve hasta tarafından bildirilen el fonksiyonlarında erken dönemde önemli iyileşmeler sağlamaktadır. Median sinir irritasyonu, geleneksel KBAS tedavisiyle iyileşme göstermeyen hastalarda potansiyel olarak tedavi edilebilir bir periferik etken olarak değerlendirilmelidir. Daha uzun takip süresi olan daha büyük prospektif çalışmalara ihtiyaç vardır. Anahtar kelimeler: kompleks bölgesel ağrı sendromu; irritatif karpal tünel sendromu; karpal tünel gevşetme; median sinir; nöropatik ağrı

Keywords

• Karpal tünel gevşetme
• İrritatif karpal tünel sendromu
• Kompleks bölgesel ağrı sendromu (KBAS)
• Nöropatik ağrı
• Median sinir

References

1. Shin SE, Haffner ZK, Chang BL, Kleiber GM. A Pilot Investigation into Targeted Muscle Reinnervation for Complex Regional Pain Syndrome, Type II. Plast Reconstr Surg Glob Open. 2022;10(12):e4718.
2. Del Piñal F. Outcomes of Carpal Tunnel Release in Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy/Sudeck Disease Patients. Plast Reconstr Surg. 2022;150(1):93-101.
3. Del Piñal F. Diagnosis and Outcomes of 225 Consecutive Cases of Complex Regional Pain Syndrome of the Hand. Plast Reconstr Surg. 2023;152(4):807-16.
4. van Eijs F, Stanton-Hicks M, Van Zundert J, Faber CG, Lubenow TR, Mekhail N, et al. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome. Pain Pract. 2011;11(1):70-87.
5. Schwartzman RJ, Alexander GM, Grothusen JR. The use of ketamine in complex regional pain syndrome: possible mechanisms. Expert Rev Neurother. 2011;11(5):719-34.
6. Piñal FD. Hand Allodynia, Lack of Finger Flexion, and the Need for Carpal Tunnel Release. J Hand Surg Am. 2023;48(4):370-6.
7. Mills M, Howell CM. Complex regional pain syndrome. Jaapa. 2023;36(8):1-5.
8. Lavigogne C, Cromheecke M, De Keyzer PB, Coeman P, Goubau J. Carpal tunnel-targeted treatment in patients with CRPS-like symptoms: a retrospective cohort study of irritative carpal tunnel syndrome. Hand Surg Rehabil. 2026:102715.

9. Cutts S, Gangoo S, Srinivasan SH, Modi N, Pasapula C, Power D. Complex regional pain syndrome: an evolving perspective. Postgrad Med J. 2021;97(1146):250-5.
10. Chappell AG, Kalainov DM, Samworth A, Yuksel SS, Rangwani S, Nader A. Permanent Peripheral Nerve Stimulator for Complex Regional Pain Syndrome of the Forearm and Hand. Plast Reconstr Surg Glob Open. 2024;12(5):e5764.
11. Shim H, Rose J, Halle S, Shekane P. Complex regional pain syndrome: a narrative review for the practising clinician. Br J Anaesth. 2019;123(2):e424-e33.
12. Del Piñal F. Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. J Hand Surg Am. 2025;50(2):130-7.
13. Placzek JD, Boyer MI, Gelberman RH, Sopp B, Goldfarb CA. Nerve decompression for complex regional pain syndrome type II following upper extremity surgery. J Hand Surg Am. 2005;30(1):69-74.
14. Koh SM, Moate F, Grinsell D. Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma. J Hand Surg Eur Vol. 2010;35(3):228-31.
15. Dellon AL, Andonian E, Rosson GD. CRPS of the upper or lower extremity: surgical treatment outcomes. J Brachial Plex Peripher Nerve Inj. 2009;4:1.
16. Dellon AL. Surgical Treatment of Upper Extremity Pain. Hand Clin. 2016;32(1):71-80.
17. Grundberg AB, Reagan DS. Compression syndromes in reflex sympathetic dystrophy. J Hand Surg Am. 1991;16(4):731-6.
18. Monsivais JJ, Baker J, Monsivais D. The association of peripheral nerve compression and reflex sympathetic dystrophy. J Hand Surg Br. 1993;18(3):337-8.
19. Thimineur MA, Saberski L. Complex regional pain syndrome type I (RSD) or peripheral mononeuropathy? A discussion of three cases. Clin J Pain. 1996;12(2):145-50.
20. Stein AH, Jr. The relation of median nerve compression to Sudeck's syndrome. Surg Gynecol Obstet. 1962;115:713-20.