Acute median neuropathy after wrist trauma. The role of emergent carpal tunnel release

Ten cases of acute carpal tunnel syndrome (ACTS) and six cases of nerve contusion were identified in patients with acute median neuropathy associated with blunt wrist trauma. The patients with ACTS initially had normal sensation and subsequently developed objective sensory loss (2-point discriminati...

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Bibliographic Details
Published inClinical orthopaedics and related research no. 300; p. 141
Main Authors Mack, G R, McPherson, S A, Lutz, R B
Format Journal Article
LanguageEnglish
Published United States 01.03.1994
Subjects
Acute Disease
Adolescent
Adult
Carpal Tunnel Syndrome - etiology
Carpal Tunnel Syndrome - surgery
Child
Contusions
Emergencies
Female
Humans
Male
Median Nerve - injuries
Middle Aged
Retrospective Studies
Time Factors
Wrist Injuries - complications
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Summary:Ten cases of acute carpal tunnel syndrome (ACTS) and six cases of nerve contusion were identified in patients with acute median neuropathy associated with blunt wrist trauma. The patients with ACTS initially had normal sensation and subsequently developed objective sensory loss (2-point discrimination greater than 15 mm) in the median nerve distribution associated with severe wrist pain. Patients with nerve contusion injuries had immediate sensory loss and symptoms were nonprogressive. Wick catheter measurements of the carpal canal pressure were used in seven patients to help distinguish ACTS (pressure greater than 40 mm Hg) from nerve contusion. The interstitial carpal tunnel pressure was elevated an average of 52 mm Hg in four of five patients with ACTS but was normal in two patients with nerve contusion. Four of five patients who underwent carpal tunnel release within 40 hours of the onset of numbness had normal 2-point discrimination within 96 hours. The results of this study and review of the literature reflect the urgency of carpal tunnel release in ACTS. Neuropathy, secondary to nerve contusion without coexisting ACTS, may be treated initially by observation. Acute carpal tunnel syndrome must be distinguished from nerve contusion as a cause of acute posttraumatic median neuropathy.
ISSN:0009-921X