Idiopathic carpal tunnel syndrome in children and adolescents

Purpose A retrospective review of a single institution's experience with idiopathic carpal tunnel syndrome (CTS) in children and adolescents was performed to evaluate management and outcomes in an effort to establish a treatment protocol. Methods All patients diagnosed with idiopathic CTS from ages 1 to 16 years of age between 1983 and 2013 were reviewed. The results of diagnostic testing and efficacy of therapeutic interventions were analyzed. The Boston Carpal Tunnel Questionnaire was sent to all patients following medical or surgical management. Results A total of 20 patients with 31 involved wrists met criteria for entrance into the study. The mean age at diagnosis was 14.4 years. Orthosis fabrication was used as the initial treatment in 30 of 31 wrists and was successful in completely alleviating symptoms in 9 of 30 wrists. A steroid injection was performed in 11 of 31 wrists, completely relieving symptoms in 5 of 11 wrists. Carpal tunnel release was performed in 10 of 31 wrists. Following surgery, patients had complete relief of symptoms in 5 of 10 wrists and partial relief of symptoms in 5 of 10 wrists. Questionnaire response incidence was 55% (11 of 20), with an average long-term follow-up of 17.6 years. Eight questionnaire respondents continued to have mild to moderate symptoms while performing activities of daily living. Conclusions Once metabolic, anatomical, and hereditary causes of pediatric CTS are ruled out, a reasonable treatment course should follow that of adults with orthosis fabrication, followed by injection, and then surgery for those that are refractory to nonsurgical treatment. Type of study/level of evidence Prognostic IV.