Carpal tunnel syndrome: is recurrence possible?



Possible recurrence of carpal tunnel syndrome

Before receiving the best treatment for carpal tunnel syndrome, it is natural to wonder about the risks of recurrence. When the median nerve is compressed within the carpal tunnel , it causes continuous pain and leads to a loss of grip strength. You’ll undoubtedly want to relieve them. However, does the treatment chosen definitively heal carpal tunnel syndrome ? Will tingling and numbness completely stop? Do you need to prepare to recurrent symptoms?

There are three possible types of recurrence; each of them corresponds to a specific treatment.

 

Recurrence of carpal tunnel syndrome after immobilisation

In the short term, immobilising the wrist can reduce the symptoms associated with carpal tunnel syndrome (CTS). In the long term, this option could overuse other joints like the elbow or shoulder. Indeed, since the brace limits wrist movements, the other joints tend to compensate this lack of mobility and may weaken.

The immobilisation period must be brief. To avoid recurrence once the brace has been removed, carefulness should be constant. Gestures and postures should be corrected to preserve the joint and relieve the carpal tunnel as much as possible. In this case, wearing a brace during activities can help you being aware of these movements. EPITACT® has developed the CARP’ACTIV™ brace* based on proprioception . It means that your wrist remains mobile but you intuitively limit and correct traumatic micromovements.

 

Recurrence after injections

Some studies(1) stressed the real benefits of corticosteroid injections in people with severe CTS. However, this improvement seems temporary: after one month, the benefits disappear. No difference was found between the group having received corticosteroid injections and the group with placebo injections. In addition, 50% of patients treated with injections presented recurrence of their symptoms the next year.

It could be interesting to carry out other studies to compare the effects of injections with conservative treatments like splints or braces associated with non-steroidal anti-inflammatory drugs.

 

Recurrence after surgery

In 80% of cases, surgery for carpal tunnel syndrome is a success. Symptoms disappear after the surgical intervention.

But in 20% of patients, either the symptoms never completely disappear (persistent symptoms) or they reappear at least 3 months after the surgery (recurrent symptoms).

Another surgical intervention is performed in 0.3% to 12% of cases.

 

Persistent symptoms

In the case of carpal tunnel syndrome , persistent symptoms consist of paraesthesia (tingling) and pain. Several reasons can explain this:

• Section of the transverse carpal ligament is partial. The median nerve is still compressed. A second surgery will allow the complete release of the nerve.
• Delay in the treatment of CTS leads to damages of the median nerve that are almost irreversible. To avoid this, it is important to consult as soon as the first symptoms appear.
• Inflammation of the synovial sheaths of the flexor tendons causes a swelling that increases pressure in the carpal tunnel and compresses the median nerve. A drug treatment will reduce the inflammation .

Identifying the cause of the persistent symptoms allows to take appropriate corrective actions. In some cases, however, it can be a diagnostic error.

 

Recurrent symptoms

If the symptoms of carpal tunnel syndrome reappear after 3 months of calm, electromyogram will confirm their recurrence.

In most cases, it happens when the median nerve has difficulties to slide during movements of the fingers and wrist. This process is often caused by fibrosis (abnormal increase of fibrous tissue) around the nerve, which takes place during healing. This additional volume impedes its sliding during some specific movements and sometimes causes pain.

This fibrosis can be the result of a surgical gesture or from postoperative complications (infection, haematoma, etc.).

If fibrosis is not extended, another surgery is possible but it is complicated and the results are variable. Most patients have sequelae.

 

To conclude, recurrence of carpal tunnel syndrome is possible after some treatments. For this reason, the priority is to consult as soon as the first symptoms appear. You can also change your habits to improve the chances of success and avoid recurrence.

 

*CARP’ACTIV™ is a class I medical device that bears the CE marking under this regulation. Carefully read the instructions before use. Manufacturer: MILLET Innovation. 03/2020

 

For more details about this general and simplified approach, here is another source: 

(1)Marshall S, Tardif G, Ashwoth N. Local corticosteroid injection for carpal tunnel syndrome . Cochrane Database Syst Rev 2007, Issue 2.

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