Purpose
The clinical features of classic carpal tunnel syndrome are well known. However, some
patients who may respond equally well to carpal tunnel release (CTR) display atypical
signs and symptoms. The chief differential features are allodynia (painful dysesthesias),
lack of finger flexion, and, on examination, pain on passive finger flexion. The goal
of the study was to present the clinical features, increase awareness, facilitate
accurate diagnosis, and report the outcomes after surgery.
Methods
Thirty-five hands, from 22 patients with the main features of allodynia and lack of
full finger flexion, were gathered in the period 2014–2021. The other common complaints
included sleeping disturbances (20 patients), hand swelling (31 hands), and shoulder
pain on the same side as the hand problem with limited range of motion (30 sides).
The Tinel or Phalen signs were obscured by the pain. However, pain with passive flexion
of the fingers was universally present. All the patients were treated with carpal
tunnel release through a mini-incision approach: four patients had a trigger finger,
which was treated concomitantly in six hands, and one patient underwent contralateral
CTR for carpal tunnel syndrome with a more standard presentation.
Results
At a minimum of 6 months of follow-up (mean, 22 months; range, 6–60 months), the pain
decreased by 7.5 ± 1.9 points on the Numerical Rating Scale, which ranges from 0 to
10. The pulp-to-palm distance improved from 3.7 to 0.3 cm. The mean Disabilities of
the Arm, Shoulder, and Hand score decreased from 67 to 20. The mean Single-Assessment
Numeric Evaluation score for the whole group was 9.7 ± 0.6.
Conclusions
Hand allodynia and lack of finger flexion may be indications of median neuropathy
in the carpal canal, which responds to CTR. Awareness of this condition is important
because the uncharacteristic clinical presentation may not be considered an indication
for surgery that can be beneficial.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: March 02, 2023
Accepted:
January 12,
2023
Received:
September 14,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
