Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis.

INTRODUCTION: The development of a carpal tunnel syndrome has become an increasingly recognized problem in patients who are treated by long-term hemodialysis. Arteriovenous fistula has been identified as one of the possible cause for the development of carpal tunnel syndrome.
MATERIALS AND METHODS: Wrists of 558 hemodialysis patients who had fistula at least 1 year served as the case group and the other intact wrists of the same patients served as the control group. Carpal tunnel syndrome was diagnosed clinically; however, 232 random patients underwent electrodiagnostic studies the day after hemodialysis.
RESULTS: In 170 (30.5%) wrists with arteriovenous fistula developed carpal tunnel syndrome versus 68 (12.2%) in the contralateral wrist. Three patients had a concurrent diagnosed radial steal syndrome. In all three wrists that had radial steal syndrome developed carpal tunnel syndrome. There was a correlation, however, between the development of the carpal tunnel syndrome, and the side of the longest vascular access. Contrary to the clinical assessment, electrodiagnostic studies did not indicate any significant association between the frequency of carpal tunnel syndrome and arteriovenous fistula or its duration.
CONCLUSION: Hemodialysis patients are at considerable risk of developing carpal tunnel syndrome in the wrist with an arteriovenous fistula. Close observation and routine clinical examination is mandatory to prevent further problems.