Idiopathic carpal tunnel syndrome in children and adolescents.
OBJECTIVE
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.


METHODS
Prognostic IV.
Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Mayo Medical School, Mayo Clinic, Rochester, MN; Division of Plastic Surgery and Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Niles J
NJ
Batdorf
Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Mayo Medical School, Mayo Clinic, Rochester, MN; Division of Plastic Surgery and Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Sean R
SR
Cantwell
Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Mayo Medical School, Mayo Clinic, Rochester, MN; Division of Plastic Surgery and Orthopedic Surgery, Mayo Clinic, Rochester, MN. Electronic address: moran.steven@mayo.edu.
Steven L
SL
Moran
D000203:Activities of Daily Living; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D002349:Carpal Tunnel Syndrome / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D009083:Mucopolysaccharidoses / Q000150:complications; D009989:Orthotic Devices; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint / Q000187:drug effects
D000305:Adrenal Cortex Hormones
Carpal tunnel syndrome; adolescent; childhood; idiopathic; pediatric