Carpal Tunnel Release: Outcomes of Pediatric and Adolescent
Filed under Diagnoses
Rapid Review. Outcomes of pediatric and adolescent carpal tunnel release based on etiology.
Velicki, K., Goldfarb, C. A., Roberts, S., & Wall, L. B. (2021). Outcomes of pediatric and adolescent carpal tunnel release. The Journal of Hand Surgery, 46(3), 178-186.
The Skinny: Less than 1% of pediatric carpal tunnel is idiopathic in nature, compared to adults where the majority of carpal tunnel is idiopathic. Limited studies have looked into the surgical outcomes of pediatric carpal tunnel release and there have been no studies comparing outcomes based on the etiology of symptoms.
In the Weeds: Twenty-three patients with 26 surgeries were enrolled in the study and grouped based on the etiology: All of these patients had hand median nerve pain or other symptoms such as numbness and tingling indicating carpal tunnel syndrome.
| Etiology | Number of Hands |
| Lysosomal storage disease | 11 hands |
| Idiopathic | 6 hands |
| Acute traumatic | 7 hands |
| Delayed traumatic | 5 hands |
| Tumorous | 2 hands |
Outcome measures included the Boston Carpal Tunnel Questionnaire (BCTQ), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
Bringing it Home: The median age for surgery was 12.7 years (range 2.5 – 23.3). All patients with tumorous etiology and acute trauma had resolution of symptoms. Those with delayed and idiopathic etiology experienced recurrent symptoms. Patients with lysosomal storage disease all experienced the gradual return of their symptoms with 2 of the patients undergoing revision carpal tunnel release.
In acute cases, carpal tunnel release was very successful in relieving median nerve pain in the pediatric population, but not always in the delayed traumatic. Approximately 50% with idiopathic carpal tunnel experienced resolution of symptoms. With lysosomal storage disease, the patient experienced relief for a few years.
Rating ⅘
There were multiple limitations in the study including a limited number of participants in each category. There was also some diagnostic uncertainty, as some of the diagnosis was based on the clinician’s judgment. Lastly, phone interviews and chart reviews were utilized to obtain outcomes data, so there were various means utilized to obtain the data, in which the interviewer could have influenced the outcomes.
More To Read
Sensory Processing in People With and Without Tendinopathy
Emilee Sanders, OTS Sensory Processing in People With and Without Tendinopathy: A Systematic Review With Meta-analysis of Local, Regional, and Remote Sites in Upper- and Lower-Limb Conditions Rio, E, Sandler, J., Cheng, K., Moseley, G. L., Cook, J., & Girdwood, M. (2021) Sensory processing in people with and without tendinopathy: A systematic review with meta-analysis…
How to Improve Fine Motor Translation Skills
By: Josh MacDonald The Basics – I lay a pile of small objects on the table and an open container for the client to put them into. What object I use depends on the client’s level. We’ll get to that later. Then, they use a 2-point pincer grasp to pick up one and shift it…
Brachial Plexopathy Case Example in Hand Therapy
Brachial Plexopathy Case Example in Hand Therapy (plexopathy examples) One of the recent cases we have seen is a 13-year old with a brachial plexus injury. We are seeing the patient post-surgery for tendon transfers to increase functional use of his left upper extremity (LUE). Before the surgery, he could not extend the wrist and…
Putting Occupation in Hand Therapy
It was early in my career, maybe a year out of school. I was working with a veteran physical therapist that had been practicing for thirty plus years. She was somewhat intimidating and one of those old school physical therapists that thrived on being aggressive. We were chatting about what areas of occupational hand therapy…
Sign-up to Get Updates Straight to Your Inbox!
Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.