Carpal Tunnel Release: Outcomes of Pediatric and Adolescent

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.

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.