Introduction. W. ide . A. wake . L. ocal . A. naesthetic . N. o . T. ourniquet (WALANT) is a well- established day case procedure for carpal tunnel release with several advantages and enhanced post-operative recovery. Use of Local anaesthesia with Adrenaline using a 27G needle allows a bloodless field and distraction techniques achieve patient comfort during the procedure. Objectives. This retrospective, observational cohort study assesses patient satisfaction and undertakes functional evaluation using the validated Boston Carpal Tunnel Questionnaire (BCTQ) following WALANT technique for carpal tunnel release (CTR). The BCTQ has a symptom severity scale based on 11 items and a functional status scale of 8 elements. Further we compare surgical outcomes between techniques of WALANT and traditional CTR. Patient and Methods. We included 30 consecutive patients, 15 in each arm who either underwent traditional CTR with the use of Tourniquet or with the WALANTtechnique. Data was collected from Electronic Patient Records and hand therapy assessments. A satisfaction questionnaire and Visual Analogue Score (VAS) was utilized to evaluate subjective outcomes. Functional outcomes was assessed by BCTQ scoring system and clinical review. Microsoft Excel was used for analysis. Results. 100% of patients in the WALANT group stated they were satisfied with the operation. Relief from night pain and sleep disturbance were the most improved symptoms. BCTQ and clinical assessment evaluation between both groups revealed comparable results with no significant difference. Conclusion. With advantages of no tourniquet related pain, increased patient satisfaction and functional outcomes on the BCTQ scores, WALANT technique has the potential to be the standard technique for CTR

Background. It was hypothesised that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression. Methods. Patients consented to randomisation to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (57 patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (61 patients). Grip strength was measured, scar pain was rated and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability pre-operatively and at eight to nine weeks following surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up. Results. There was no difference between the groups with respect to age, sex, hand dominance or side of surgery. Grip strength, scar pain and Patient Evaluation Measure score were not significantly different between the two groups, although there was a trend towards poorer subjective outcome as demonstrated by the questionnaire in the group in which the ulnar bursa within the carpal tunnel had been preserved. Preserving the ulnar bursa within the carpal tunnel did however result in a lower prevalence of suspected wound infection or inflammation (p=0.04). Conclusions. In this group of patients, preservation of the ulnar bursa around the median nerve during open carpal tunnel release produced no significant difference in grip strength or self-rated symptoms. We recommend incision of the ulnar bursa during open carpal tunnel decompression to allow complete visualisation of the median nerve and carpal tunnel contents

Carpal tunnel syndrome is the most frequent form of median nerve entrapment, accounting for 90% of all entrapment neuropathies. Routinely nerve conduction study (NCS) tests are ordered to confirm the diagnosis however; there are issues of long waiting periods and costs with it. We aimed to compare carpal tunnel questionnaire score (CTQS) by Kamath and Stothard (2003) to nerve conduction study result in the diagnosis of carpal tunnel syndrome. This prospective study involved analysis of data from all the patients referred to NHS Tayside (Dundee) hand clinic with signs and symptoms of Carpal tunnel syndrome (CTS) from September 2016 to February 2017. Statistical analysis was done using SPSS and sensitivity and specificity was calculated. The questionnaires were filled in by a team of specialist physiotherapists. Nerve conduction study tests were done by a team of consultant neurophysiologists. Both the groups were blinded to each other's assessment. We analysed 88 patients who filled in CTQS and also underwent NCS. We noted that CTQS of less than 3 correlated 100% to negative nerve conduction result. When the carpal tunnel questionnaire score was more than or equal to 5, 54 patients had positive NCS result and 6 patients had negative NCS result, giving a 90% predictability of a positive NCS result. Mean waiting period of carpal tunnel patients for NCS was 141 days. We noted from this prospective study that CTQS was sensitive enough to exclude carpal tunnel syndrome when the questionnaire score was less than 3. In addition, the questionnaire revealed a 90% probability of having carpal tunnel syndrome when CTQS was more than or equal to 5. Based on the present study, we would recommend that patients in grey zone of 3 to 4 on questionnaire should undergo NCS, resulting in only 20% of patients (based on the figures from the current study) being referred for NCS. The questionnaire can be used in primary health care or specialist physiotherapy screening clinic as a tool for diagnosing CTS with implications of cost saving and avoiding long waiting periods

Utilization of nerve conduction studies in the investigation and management of carpal tunnel syndrome varies according to their perceived usefulness and availability. The use of steroid injections and splinting also varies according to service availability and their perceived effectiveness. We present a three year follow up of 230 patients managed in an environment where nerve conduction testing was not readily available. The majority received splinting and a steroid injection in an effort to manage their symptoms conservatively in the first instance. Our results show that a clear majority of patients who were treated with initial splinting and steroid injections saw a recurrence of their symptoms (71.9% and 79.7% respectively) requiring eventual surgical decompression. These results would seem to suggest that conservative management of carpal tunnel does not produce the desired curative results and that there may be an argument for proceeding directly to surgery. We also showed that 55% of patients referred for Nerve Conduction Studies seem to progress to surgical decompression. This would seem to suggest that Nerve Conduction Studies could form a robust part of the standard investigation of carpal tunnel in order to identify those who would benefit from surgery

This study compares the endoscopic carpal tunnel release with the conventional open technique with respect to short and long-term improvements of functional and clinical outcomes. We assessed 72 outpatients diagnosed with carpal tunnel syndrome. Thirty-seven patients underwent the endoscopic method according to Chow and 35 were assigned to the open method. Improvement in symptoms, severity and functionality were evaluated shortly preoperatively (at two days, one week and two weeks) and one year after using the Symptom Severity Scale, Symptom Severity Status and DASH questionnaire. Changes in clinical outcomes (grip strength, key pinch and two-point discrimination test) were evaluated one year postoperatively. Complications were also assessed. Both groups showed similar improvement in all but one outcome one year after the release; increase in grip strength was significantly higher for the endoscopic group. The endoscopic method was also associated with a significantly faster short-term improvement. Separate analysis of the questionnaire components referring to pain reveals that the delay of improvement in the open group is due to the persistence of pain for a longer period. Paresthesias and numbness decrease shortly after the operation with comparable rates for both groups

Carpal tunnel syndrome (CTS) is the most common condition affecting the hand, with a prevalence of 2–3% in most populations, and a lifetime incidence over 10%. There is consensus that CTS results from increased pressure in the carpal tunnel, which eventually affects nerve function, but, aside from direct trauma and space occupying lesions, there is no consensus on what causes the pressure to rise. In the absence of an identifiable biological mechanism, the most common treatment involves surgical opening of the carpal tunnel. Recent data suggests that CTS patients demonstrate, in the carpal tunnel synovium and subsynovial connective tissue (SSCT), evidence of cellular senescence, with a senescence associated secretory phenotype (SASP). This finding suggests the potential for a biological treatment for CTS with senolytic drugs. This presentation will review the evidence for CTS as a disease of cellular senescence, and our preliminary data on the effects of senolytics, including in a relevant animal model of CTS and SSCT fibrosis

Objective. Carpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design. Methods. Eighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695. Results. Statistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice. Conclusion. Insights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed

Aims. The sensitivity and specificity of electrodiagnostic parameters in diagnosing carpal tunnel syndrome (CTS) have been reported differently, and this study aims to address this gap. Methods. This case-control study was conducted on 57 cases with CTS and 58 controls without complaints, such as pain or paresthesia on the median nerve. The main assessed electrodiagnostic parameters were terminal latency index (TLI), residual latency (RL), median ulnar F-wave latency difference (FdifMU), and median sensory latency-ulnar motor latency difference (MSUMLD). Results. The mean age in cases and controls were 50.7 years (SD 9.9) and 47.9 years (SD 12.1), respectively. The CTS severity was mild in 20 patients (34.4%), moderate in 19 patients (32.8%), and severe in 19 patients (32.8%). The sensitivity and specificity of the electrodiagnostic parameters in diagnosing CTS were as follows: TLI 75.4% and 87.8%; RL 85.9% and 82.5%; FdifMU 87.9% and 82.9%; and MSUMLD 94.8% and 60.0%, respectively. Conclusion. Our findings indicated that electrodiagnostic parameters are significantly associated with the clinical manifestation of CTS, and are associated with high diagnostic accuracy in CTS diagnosis. However, further studies are required to highlight the role of electrodiagnostic parameters and their combination in CTS detection. Cite this article: Bone Jt Open 2024;5(10):898–903

Outcomes following carpal tunnel release are generally favorable. Understanding factors that contribute to inferior outcomes may allow for strategies targeted at improving results in these patients. Our purpose was to determine if patients' underlying personality traits, specifically resiliency and catastrophization, impact their post-operative outcomes following carpal tunnel release. A prospective case series was performed. Based on our power analysis, 102 patients were recruited. Patients completed written consent, the Boston Carpal Tunnel Questionnaire (BCTQ), the Pain Catastrophizing Scale (PCS) and the Brief Resiliency Scale (BRS). A single surgeon, or his resident under supervision, then performed an open carpal release under local anaesthetic. Our primary outcome measure was a repeat BCTQ at three- and six-months. Univariate and multivariate analysis was performed to assess the correlation between PCS and BRS scores and final BCTQ scores. Forty-three and sixty-three participants completed the BCTQ at three and six months respectively. All patients showed improvement in their symptoms (p = 0.001). There was no correlation between patients PCS or BRS and the amount of improvement. There was also no correlation between PCS or BRS and the patients' raw scores at baseline or follow-up. Patients self-assessed resiliency and degree of pain catastrophization has no correlation with the amount of improvement they have three or six months post-operatively. Most patients improved following carpal tunnel release, and patients with low resiliency and high levels of pain catastrophization should expect comparable outcomes to patients without these features

The median nerve compression in the carpal tunnel is the most common compression syndrome of the upper limb. In most cases it is idiopathic but may also occur from anatomical, traumatic, endocrine, rheumatic or tumoral causes. Chow's endoscopic technique was initially used to treat this disease and then modified to a mini-open approach through a single palmar incision. This incision is similar to the one used in endoscopic release by Agee. After exposing the proximal part of the transverse carpal ligament a meniscus knife is advanced until there is a complete section of the ligament, without endoscopic equipment. Between 2004 and 2006, 200 hands in 179 patients with a diagnosis based on clinical and electromyographic criteria were operated by this mini-open technique. The mean follow-up was 49 months (minimum of 34 months and a maximum of 70 months). 50 randomly selected patients were submitted to the self-administered Boston questionnaire. 50 patients treated by the minimal-incision decompression during the same period were also given the questionnaire. The aesthetic satisfaction was registered as well as if they would have surgery on the other hand or would recommend the procedure. This mini-open technique is another technique available to the surgeon that allows very similar functional results to endoscopic surgery, without use of specific material and with a shorter surgical time

Carpal tunnel syndrome is the commonest nerve entrapment syndrome. There is still controversy over the method of anaesthesia for this procedure. There have been many studies to show the effectiveness of local infiltration anaesthesia. However, patients do not always tolerate it, as one of the disadvantages of local anaesthetic is pain on infiltration. Experimental studies have shown that warming local anaesthetic can reduce the pain of injection in normal subjects. The aim of our study is to assess the effect of warming local anaesthetic for carpal tunnel surgery. We conducted a prospective randomised controlled trial. Sample size was calculated. The study group consisted of patients undergoing carpal tunnel surgery. The treatment group received local anaesthetic at 37°C, the control group at room temperature. Patients were asked to indicate the degree of discomfort on a visual analogue scale (0 to 100). There was a significant reduction in pain scores in the treatment group. Warming the local anaesthetic produced a mean visual analogue score of 13.8 versus 43 for the control group. These results were statistically significant (p< 0.05). Many carpal tunnel releases are performed under General Anaesthetic . One of the main reasons cited was poor patient tolerance to local anaesthetic infiltration due to pain. Our results show a significant reduction in the reported pain by warming the local anaesthetic for carpal tunnel release. We suggest that warming local anaesthetic should be best practice for anaesthesia in carpal tunnel release

Introduction and Aims: It has been suggested that elderly patients have poorer outcomes following carpal tunnel decompression than younger patients, especially if there is severe compression. The purpose of this study was to determine the outcomes of carpal tunnel decompression in the elderly patient and whether the outcome could be predicted from pre-operative nerve conduction studies. Method: A retrospective study of all patients over 70 years who had a carpal tunnel release over a three-year period at Dunedin Hospital, with a minimum one-year follow-up. Pre-operative nerve conduction studies were graded from one to six according to severity. Patients were followed up by postal questionnaire (Boston carpal tunnel symptom severity score) and telephone follow-up. Results: 109 procedures were performed in 96 patients. Eight patients had died, two excluded (one with Motor Neurone disease and one acute CTS following fracture) and five were demented and unable to fill out the questionnaire. Eighty-one patients with 92 wrists were available for review. Mean age was 78.6 years. Eighty percent had marked to severe neurophysiological changes (Grade 4–6). Post-operatively, the median Boston score was 1.27 with 84% having a Boston score of < 2.0. Patients were satisfied with the result in 94.6% of procedures. There was a positive correlation between nerve conduction grade and post-operative Boston Score (p=0.042). Conclusion: Despite nerve conduction studies consistent with marked to severe compression, elderly patients have low symptom severity scores following carpal tunnel decompression and a high rate of satisfaction. Carpal tunnel release in patients over 70 years of age is justified and usually associated with a good outcome

Hypothesis. Does the result of steroid injection in the carpal tunnel in a patient with recurrent carpal tunnel symptoms provide a good predictor of the outcome of later carpal tunnel release (CTR). Methods. A retrospective review of all patients who underwent revision CTR for recurrent or persistent carpal tunnel syndrome (CTS) over a two year period was conducted. A total of 23 patients and 28 wrists met inclusion criteria. Patients were evaluated to determine if pre-operative factors or result of injection predicted the outcome of revision CTR. A multivariate logistic regression analysis (MLRA) was used to predict surgical success when multiple pre-operative findings were considered. Results. No patient characteristic or physical exam finding was found to predict successful revision CTR. Twenty-two (86.4%) of patients who had relief from injection had symptom relief/improvement with revision CTR whereas only 4 (13.6%) were not improved by the surgery; the difference was not statistically significant. The sensitivity and positive predictive value for injection alone predicting outcome of revision CTR was 86.4%. MLRA combining injection results with physical exam findings (Numbness and/or motor weakness in median nerve distribution, Positive Durkin's, and Positive Phalen's test) provided a sensitivity of 100% and specificity of 80%. Conclusions. In contrast to primary CTS, cortisone injection into the carpal tunnel in the face of recurrent CTS is not, by itself, a statistically significant predictor of successful revision surgery. However, patients with a positive result from injection had an 86.4% success with revision CTR with an average DASH score of 28.87. Relief from injection as a diagnostic test for success from revision CTR was found to have both high sensitivity and positive predictive value. Coupled with the components of the physical examination, injection provides a good screening test to establish success with revision CTR, sensitivity of 100% and specificity of 80%

Introduction A randomised, double blind controlled study of the short term results of single portal endoscopic carpal tunnel release (ECTR) versus open carpal tunnel release (OCTR) is presented. Methods Twenty patients undergoing bilateral carpal tunnel release were inducted into the study. Each patient had one side performed as an ECTR and the other as an OCTR. The side that ECTR was performed on was randomised. Assessment was performed at one, two and six weeks post-operatively by the patient and a blinded hand therapist. The patient was blinded at the one week review. Assessment looked at pain, function and satisfaction, as well as objective strength and motion. Results All patients prefered the side of the endoscopic release at one, two and six weeks. ECTR was associated with less pain, greater ease of use, improved strength and better motion. Conclusions There is a significantly improved short term outcome, on both subjective and objective measures, with endoscopic carpal tunnel release compared to open carpal tunnel release

Introduction and Objective. Carpal tunnel syndrome (CTS) is a very common compressive neuropathy involving the median nerve. The typical symptoms are paraesthesia, dysesthesia and loss of strength; in severe case, this compression deteriorates the sensorimotor control of the hand and interferes with the adjustment of the forces at the level of the fingers, thus affecting the components that are the basis of dexterity and control of fine movements. For these reasons, the CTS has repercussions on various activities of daily life, including writing skills. Word processing via PC and mobile device (touch-typing) require a fine control of the hand-wrist movement and of the opposition of the thumb, while in handwriting, gripping and gripping movements are carried out in a protracted manner. In modern society, present skills play a role of fundamental importance from an educational, professional and social point of view. The aim of the study is to describe the effects of carpal tunnel release (CTR) on handwriting and digital writing performance. Materials and Methods. We recruited patients suffering from carpal tunnel syndrome (CTS) who were candidates for CTR surgery and collected clinical and demographic data, including age, occupation, duration of symptoms and electromyography outcomes. The first trial session was carried out before surgery and the subsequent ones at 1, 2, 3, 4, 8 and 12 weeks after the CTR. These trials involved copying a 500-character paragraph by handwriting, personal computer (PC) and mobile device, for which a dedicate Google Colab web page was computed. We used as parameters the speed, expressed in words per minute (wpm), and the accuracy of copying, which was measured in number of errors (en). Moreover in each session the patient filled in the QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire. We used the one-way anova to evaluate the change in the three performances and in the QuickDASH score in follow-up sessions. We used the two-way anova to detect a possible interactions between speed improvement and groups of variables, namely gender, writing frequency, schooling, diabetes, dysthyroidism and metabolic syndrome. Results. We recruited 20 patients of whom 7 dropped out for personal reasons and 13 had completed all trial sessions. The PC writing performance had an average speed and accuracy of 15.1 ± 6.8 wpm and 13.1 ± 8.2 en, respectively, while post-operatively it returned values of 17.6 ± 5.0 wpm and 9.9 ± 5.6 en. Regarding touch-typing, a pre-operative average of 16.9 ± 5.8 wpm and 14.3 ± 14.4 en was recorded, while post-operatively an average of 21.7 ± 6.5 wpm and 11.5 ± 14.7 en was reported. Handwriting performance initially had a mean of 20.5 ± 7.1 wpm and 0.1 ± 0.6 en and after three months returned a mean of 22.4 ± 4.0 wpm and 0 ± 0 n. The QuickDASH score had a pre-operative mean of 39.1 ± 9.1 and post-operative mean of 17 ± 6 points. The only statistically significant improvements were those related to touch-typing (P = 0.022) and QuickDASH score (P < 0.001). There was no significant interaction between gender, comorbidity, writing frequency, level of schooling and recovery of writing ability. Conclusions. The data collected showed, in agreement with previous studies, that CTS has a significant impact on the patient's writing ability, who benefits from the surgical treatment, especially in terms of touch-typing and general manual dexterity. In addition, the recovery of writing ability did not show significant correlation with other variables

Aims: To investigate the effect of age and occupation on the outcome of carpal tunnel decompression. Patients and Methods: A total of 271 patients undergoing primary carpal tunnel decompression by a single surgeon were studied. Patients with inflammatory joint disease, thyroid disease and diabetes mellitus were excluded. Outcome was assessed using the Levine-Katz carpal tunnel questionnaire at two weeks preoperatively and six months postoperatively. Cases were divided into six age groups (less than 40 years of age, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and over 80 years of age) and 12 occupational groups according to the International Standard Classification of Occupations (ISCO-88). Statistical analysis was performed using one-way analysis of variance (ANOVA) and post ad-hoc analyses. Results: Overall there was an improvement in total Levine scores in 269 (99.3%) patients (mean change 33.1, 95%CI: 31.5 to 34.7). This change was greatest in those over 80 years of age (mean 35.8, 95%CI: 29.0 to 42.6) and in those who were service or sales workers (mean 39.6, 95%CI: 34.9 to 44.2), and least in the 70–79 age group (mean 30.7, 95%CI 25.7 to 35.8) and craft and trade workers (mean 29.8, 95%CI: 21.8 to 37.9). Patients reported a greater improvement in symptoms (mean score change 21.4, 95%CI: 20.2 to 22.2), than function (mean 12, 95%CI: 11.1 to 12.7). We found no significant difference in the total, functional or symptomatic Levine score changes between the six age groups (p=0.05) and the 12 occupation groups (p=0.05) following carpal tunnel decompression. Conclusion: Almost all patients improved after carpal tunnel decompression. However, we found no influence of age and occupation on the outcome of carpal tunnel decompression in our series of patients

Background. To investigate the new theory of hydroneurolysis and hydrodissection in the treatment of carpal tunnel syndrome (CTS). Independently of the fluid hydrodissolution works due to mechanical forces and it may have some positive effects in patients with ischemic damage caused by scar tissue pressure at the nerve's surface. Methods. A prospective blind clinical study of 31 patients suffering from carpal tunnel syndrome, established by nerve conduction studies and clinical tests. 14 patients (out of 29), who refused to undergo an open operation as a treatment to their disease at this point of time, were treated with a simple ultrasound-guided injection at the proximal carpal tunnel. In order to exclude the biochemical influence of the fluid in the treating disease we choosed to infiltrate 3 cc. of normal saline 0,9%. In the follow-up period our group was asked to answer to a new Q-DASH score and visual analogue scale (VAS) 100/100 in 2, 4 and 8 weeks. Results. At the end of the second month we found only 2 out of 14 patients of the infiltration's group with clinical improvement. As far as the control group (17 patients), there was just one patient with recovery of the symptoms at the end of the second month who avoided operation. The rest 16 patients experienced insistence or worsening of CTS while they were waiting to be operated (mean time till operation in our department's waiting list: 2 months) and underwent a surgical decompression of the median nerve. Comparing the two groups in Q-DASH score, VAS 100/100 and ultrasound cross sectional area measurements we found no statistical difference between the two groups at the endpoint of our follow-up period. Conclusion. As far as nerve entrapment syndromes we proved that normal saline hydrodissolution appears to be non effective as a conservative treatment. The mechanical way of action seems to have only very short term effects. Level of Evidence. II

To compare the efficacy of local steroid injection with surgical decompression in treatment of carpal tunnel syndrome (CTS) in terms of frequency of pain. This randomized controlled study was conducted at the Department of Orthopaedics for a duration of 01 year, i.e. from 20th April 2016 to 19th April 2017. 130 patients with carpal tunnel syndrome with moderate (Grade 2) and severe (Grade 3) pain were included. Lottery method was used to allocate the patients randomly into two groups. Group A contained 65 patients who were subjected to surgical decompression and 65 patients were in Group B who were injected with local steroid injection. Complete history was obtained from all patients. All the surgical decompressions through mini incision technique and injections procedures were performed. Information were recorded in a pre designed Performa. Efficacy was observed significantly high in group B as compared to group A (87.7% vs. 72.3%, p=0.028). Carpal Tunnel syndrome symptoms were alleviated with surgical decompression as well as local steroid injection at a follow up done after 1 month. However the steroid injections seem to have greater efficacy than surgical decompression, hence we suggest it for routine treatment of all patients with CTS. For any reader queries, please contact . virgo_r24@hotmail.com

Introduction: Carpal tunnel syndrome is frequent in children with mucopolysaccharidosis. Diagnosis is difficult according to the slow progression of compression of the medial nerve and treatment is controversial. Material & Methods: Twelve children were studied: 8 Hurler’s, 2 Hunter’s and 2 Maroteaux-Lamy’s diseases. All had clinical and EMG evaluation. Eight of them were operated, both sides. Results: All the children had progressive and severe hypoesthesia before surgery. Nerve conduction velocity was very slow compared to normal values. After the open surgical release (16 cases) and synovectomy of flexor tendons (13 of 16 cases), all the patients were improved. The histology of the synovitis showed less glycosaminoglycans in patients who had a bone marrow transplantation. Surgical treatment must be an open release of the anterior ligament associated with a synovectomy of flexor tendons and a ventral epineurotomy. Discussion: According to the literature, carpal tunnel syndrome is observed in two third of patients of type I, II and VI mucopolysaccharidosis. Diagnosis is often difficult when cervical compression of the spinal cord is an associated factor. The diagnosis is made with clinical and EMG evaluation. Treatment must be early. MRI is an alternative to evaluate the morphology of the nerve: its compression below the carpal ligament and its bulky aspect just proximal to the carpal tunnel are clearly shown

We aimed to prospectively assess the familial incidence of Carpal tunnel syndrome (CTS). 151 patients undergoing elective carpal tunnel surgery at a district general hospital were given a written questionnaire on the day of surgery. Patients were asked to give details of all adult family members and to identify relatives that had been diagnosed with CTS by a doctor or had undergone CTS surgery. CTS is commonly associated with pregnancy, trauma, hypothyroidism, diabetes, gout and rheumatoid arthritis. We asked if the patients had any of these conditions. All patients were contacted by telephone within one month of surgery to validate the data collected. The average age was 58. 4 (Range 28 – 84). The female / male ratio of patients undergoing surgery was 4A. Overall 26% of patients had a relative with CTS. 7. 8% of children (aged > 20), 2. 4% of parents and 4. 2% of siblings were affected. A study of 44, 233 US workers reported a prevalence of 1. 55%. The child of a person with CTS is therefore 5 times more at risk of developing CTS than the normal population. Many parents were deceased resulting in a lower recorded prevalence for this group. Familial CTS was more common than any of the conditions traditionally associated with CTS (Except pregnancy). Familial Carpal Tunnel Syndrome is common. Family history should be enquired about in occupations at risk of developing carpal tunnel syndrome