Management of carpal tunnel syndrome in renal dialysis patients using an extended carpal tunnel release procedure.

Abstract

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. 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. 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. Carpal tunnel decompression enhances hand function and quality of life in this group.