Complex Regional Pain Syndrome after Carpal Tunnel Syndrome Surgery: A Systematic Review. 2022

Luis Henrique A Sousa, and Caroline de O Costa, and Eduardo M Novak, and Giana S Giostri
Division of Neurosurgery, Cajuru University Hospital, Curitiba, Brazil Cajuru University Hospital, Curitiba, Brazil.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. One of the most devastating complications is complex regional pain syndrome. The aim of this study was to systematically analyze available evidence about complex regional pain syndrome after carpal tunnel syndrome surgery (CTSS), its risks, associated factors, and treatments. Research conducted from 1962 through December 31, 2018, in the following databases: PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. The quality assessment of the methodology followed the definitions by the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The GRADE system (Grades of Recommendation, Assessment, Development, and Evaluation) was applied to evaluate the efficacy of the stellate ganglion block, one of the most cited and recurrent treatments. Of the 246 studies retrieved, 44 articles were included. Concerning patients' gender, we identified a ratio of 5 females: 3 males. The mean age for women was 57.79, a standard deviation of 14.96, and for men 60.75, a standard deviation of 9.4. Considering the total of primary publications of CTSS outcomes, the accumulated incidence reached the maximum of 0.15 CRPS after CTSS patients/CTSS patients. The known risk factors for CRPS after CTSS: female gender, from the fifth decade of life, tourniquet time, immobilization and surgery on dominant hand. CRPS affects 2-5% of people undergoing CTSS. Its diagnosis is still a challenge and its risk factors are unclear, although it seems more likely to affect women, in the dominant hand. The most used treatments include physiotherapy and stellate ganglion block. Most patients show improvement of symptoms within one year. Further clinical trials comparing treatment modalities are required.

UI MeSH Term Description Entries
D008297 Male Males
D002349 Carpal Tunnel Syndrome Entrapment of the MEDIAN NERVE in the carpal tunnel, which is formed by the flexor retinaculum and the CARPAL BONES. This syndrome may be associated with repetitive occupational trauma (CUMULATIVE TRAUMA DISORDERS); wrist injuries; AMYLOID NEUROPATHIES; rheumatoid arthritis (see ARTHRITIS, RHEUMATOID); ACROMEGALY; PREGNANCY; and other conditions. Symptoms include burning pain and paresthesias involving the ventral surface of the hand and fingers which may radiate proximally. Impairment of sensation in the distribution of the median nerve and thenar muscle atrophy may occur. (Joynt, Clinical Neurology, 1995, Ch51, p45) Compression Neuropathy, Carpal Tunnel,Entrapment Neuropathy, Carpal Tunnel,Amyotrophy, Thenar, Of Carpal Origin,Median Neuropathy, Carpal Tunnel,Carpal Tunnel Syndromes,Syndrome, Carpal Tunnel,Syndromes, Carpal Tunnel
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D020918 Complex Regional Pain Syndromes Conditions characterized by pain involving an extremity or other body region, HYPERESTHESIA, and localized autonomic dysfunction following injury to soft tissue or nerve. The pain is usually associated with ERYTHEMA; SKIN TEMPERATURE changes, abnormal sudomotor activity (i.e., changes in sweating due to altered sympathetic innervation) or edema. The degree of pain and other manifestations is out of proportion to that expected from the inciting event. Two subtypes of this condition have been described: type I; (REFLEX SYMPATHETIC DYSTROPHY) and type II; (CAUSALGIA). (From Pain 1995 Oct;63(1):127-33) Acute Regional Pain Syndrome,Chronic Regional Pain Syndrome,Complex Regional Pain Syndrome,Pain Syndromes, Regional Complex,CRPS (Complex Regional Pain Syndromes)
D026741 Physical Therapy Modalities Therapeutic modalities frequently used in PHYSICAL THERAPY SPECIALTY by PHYSICAL THERAPISTS or physiotherapists to promote, maintain, or restore the physical and physiological well-being of an individual. Physical Therapy,Physiotherapy (Techniques),Group Physiotherapy,Neurological Physiotherapy,Neurophysiotherapy,Physical Therapy Techniques,Group Physiotherapies,Modalities, Physical Therapy,Modality, Physical Therapy,Physical Therapies,Physical Therapy Modality,Physical Therapy Technique,Physiotherapies (Techniques),Physiotherapies, Group,Physiotherapy, Group,Physiotherapy, Neurological,Techniques, Physical Therapy,Therapy, Physical

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