Short-Term Outcomes of Carpal Tunnel Release in Patients with CRPS-Like Symptoms

ABSTRACTIntroductionSome patients diagnosed with complex regional pain syndrome (CRPS) may have an underlying peripheral nerve trigger, including mechanical irritation of the median nerve within the carpal tunnel. This study evaluated the short-term outcomes of carpal tunnel release in adults with persistent CRPS-like symptoms and suspected irritative carpal tunnel syndrome.MethodsThis retrospective case series included adult patients who underwent mini-open carpal tunnel release after failing at least three months of medical treatment and hand therapy. Patients were assessed preoperatively and six weeks postoperatively using the visual analog scale (VAS), Patient-Specific Functional Scale (PSFS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, grip strength, and tripod pinch strength. Preoperative and postoperative values were compared using the two-sided exact Wilcoxon signed-rank test.ResultsThere were eight patients with a mean age of 55 ± 13.2 years. The median VAS score decreased from 8 to 0, the median PSFS score increased from 2.9 to 8.1, and the median DASH score decreased from 64.5 to 16.5 at six weeks postoperatively (p = 0.008 for all comparisons). Median grip strength increased from 8.3 to 10.2 kg, and median tripod pinch strength increased from 2.9 to 3.7 kg.ConclusionsCarpal tunnel release was associated with significant short-term improvements in pain and patient-reported hand function in selected adults with persistent CRPS-like symptoms and suspected irritative carpal tunnel syndrome. Median nerve irritation should be considered as a potentially treatable peripheral contributor in patients who do not improve with conventional CRPS treatment. Larger prospective studies with longer follow-up are needed.Keywords: complex regional pain syndrome; irritative carpal tunnel syndrome; carpal tunnel release; median nerve; neuropathic pain