June 16, 2014
There is a controversy about how patients treated for carpal tunnel syndrome who depend on being able to operate independently in a wheelchair will come out. A historic article from Ranchos Los Amigos in Los Angeles years ago claimed, in general, a poor result in carpal tunnel release in paraplegics, but it wasn’t a very good study- it was retrospective. Another study by Upton in Boston (JHS 1988) looked at 60 male paraplegic patients. The incidence of abnormal NCS on the symptomatic vs. non-symptomatic side was not predictable with either age or duration of paralysis. Forty-four percent of the patients with an abnormal nerve conduction study were asymptomatic. This is a small study in which a high percentage of the people who had abnormal nerve studies on a side where they were symptomatic or not. Their research suggests testing people more liberally that come in with symptoms that sound like they were possibly carpal tunnel related.
From my experience, paraplegic patients undergoing endoscopic carpal tunnel release do as well as the non-paraplegic patient, but I do pay a little more attention to coverings of the hands so that they can leave the hospital in a wheelchair that they came in and avoid getting wound contamination and resultant infection.