Armin Pallaver1, Silvia Schibli1, Jan Fridén2. 1. Swiss Paraplegic Centre, Nottwil, Switzerland. 2. Swiss Paraplegic Centre, Nottwil, Switzerland. jan.friden@paraplegie.ch.
Abstract
STUDY DESIGN: A retrospective chart audit. OBJECTIVES: To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making. SETTING: Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Retrospective investigation of medical history, diagnostics, surgeries, and outcomes of surgical treatments of CTS in patients with para- and tetraplegia. RESULTS: We identified a total of 77 surgeries for CTS in 55 patients: 16 females (25 surgeries) and 39 males (52 surgeries) with spinal cord injury. The majority (47 persons, 68 surgeries) were paraplegic (level of lesion Th2 and below); 8 persons (9 surgeries) were tetraplegic (level of lesion Th1 and above). ASIA scores in the tetraplegic group were A: 0, B: 1, C: 4, D: 3 while complete lesions predominated in the paraplegic group (A: 32, B: 4, C: 5, D: 6). Sixty-six out of 77 patients reported total relief of symptoms. Neither nerve conduction velocity nor motor amplitude correlated well with the severity of CTS. Co-morbidity and specific risk factors were rare. CONCLUSIONS: SCI patients with CTS respond well to surgical decompression of median nerve regardless of level and type of spinal cord lesion and risk factors. Nerve conduction parameters and clinical findings can provide additional diagnostic support of CTS although nocturnal hand paresthesia, wrist pain at and after loading as well as failed conservative treatment are the main indications for surgical interventions. Based on symptomatology, clinical findings, and nerve conduction studies, we propose a decision-making tree for suggesting surgery or not.
STUDY DESIGN: A retrospective chart audit. OBJECTIVES: To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making. SETTING: Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Retrospective investigation of medical history, diagnostics, surgeries, and outcomes of surgical treatments of CTS in patients with para- and tetraplegia. RESULTS: We identified a total of 77 surgeries for CTS in 55 patients: 16 females (25 surgeries) and 39 males (52 surgeries) with spinal cord injury. The majority (47 persons, 68 surgeries) were paraplegic (level of lesion Th2 and below); 8 persons (9 surgeries) were tetraplegic (level of lesion Th1 and above). ASIA scores in the tetraplegic group were A: 0, B: 1, C: 4, D: 3 while complete lesions predominated in the paraplegic group (A: 32, B: 4, C: 5, D: 6). Sixty-six out of 77 patients reported total relief of symptoms. Neither nerve conduction velocity nor motor amplitude correlated well with the severity of CTS. Co-morbidity and specific risk factors were rare. CONCLUSIONS: SCI patients with CTS respond well to surgical decompression of median nerve regardless of level and type of spinal cord lesion and risk factors. Nerve conduction parameters and clinical findings can provide additional diagnostic support of CTS although nocturnal hand paresthesia, wrist pain at and after loading as well as failed conservative treatment are the main indications for surgical interventions. Based on symptomatology, clinical findings, and nerve conduction studies, we propose a decision-making tree for suggesting surgery or not.
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