Management of carpal tunnel syndrome in renal dialysis patients using an extended carpal tunnel release procedure.
BACKGROUND
Chronic dialysis patients are susceptible to median nerve compression. This may be due to oedema or vascular insufficiency related to a dialysis shunt or fistula. Patients with renal failure may also develop amyloid disease. Amyloid infiltration of the synovium within the carpal canal may be a contributing factor to the nerve compression. Traditional carpal tunnel release, although simple to perform, is associated with a much higher recurrence rate in this group than in nonrenal patients. Our aim was to modify the carpal tunnel release procedure and prevent these recurrences.


METHODS
A retrospective review of 24 extended carpal tunnel decompressions in 19 dialysis patients was performed, with reference to patient records. The surgical technique is detailed and the clinical results analysed.


RESULTS
All patients noted an early and sustained improvement in symptoms; those patients with established sensory or motor signs had poorer results following surgery. There were no instances of recurrence of nerve compression during this follow-up period, range 2-6 years.


CONCLUSIONS
Carpal tunnel decompression enhances hand function and quality of life in this group.
Wilson
S W
SW
Department of Plastic Surgery, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
Pollard
R E
RE
Lees
V C
VC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D020127:Recovery of Function; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome