Complication and prognosis of CTS

Prognosis

• CTS can range from a minor inconvenience to a disabling condition, depending on its cause and persistence and the individual characteristics of the patient. Many cases of CTS are mild, and when symptoms don't last long, they often resolve (disappear) on their own. Once a woman with pregnancy-associated CTS gives birth, for instance, the swelling in her wrists and other symptoms almost always subside.
  
• CTS during pregnancy seem to be less severe than idiopathic CTS and has milder course with fewer cases requiring surgical treatment.
  
• Proper treatment of other medical conditions that cause CTS can often help reduce wrist swelling.
  
• Prognosis is excellent with proper treatment
  
• Whether any conservative management can prevent progression is unclear.
  
• Even with surgical release, it appears that the syndrome recurs to some degree in a significant number of cases (possibly in up to one third after 5 years).²⁰
  
  
• Despite treatment, some patients may have residual fingertip numbness.
  
• Initially, approximately 90% of mild to moderate CTS cases respond to conservative management. Over time, however, a number of patients progress to requiring surgery.
  
• Patients with CTS secondary to underlying pathology (eg, diabetes, wrist fracture) tend to have a less favorable prognosis than do those with no apparent underlying cause.
  

Complications

• Basically, the complications of CTS are:
  
  • Muscle weakness
    
  • Peripheral neuropathy
    
  • Paresthesia
    
• If the condition is treated properly, there are usually no complications.
  
• Carpal tunnel syndrome (CTS) appears to be progressive over time (although with considerable fluctuations from week to week) and can lead to permanent median nerve damage.
  
• If untreated, carpal tunnel syndrome may continue to increase median nerve damage, leading to permanent impairment and disability. (chronic hand weakness and numbness followed by chronic disability)
  
• Some individuals can develop chronic wrist and hand pain (with or without reflex sympathetic dystrophy).
  

Complications of surgery

Treatment failure and complication rates of CTS surgery vary.

Complications after surgery may include the following:

• Nerve damage with tingling and numbness (usually temporary)
  
• Infection
  
• Scarring
  
• Pain
  
• Stiffness
  
• Loss of some wrist strength is a complication that affects 10% to a third of patients. Endoscopy may have better results than open release. Some patients who have jobs requiring significant strength of the hand and wrist may not be able to perform them after surgery. These workers may also have problems in other parts of the upper body, including elbows and shoulders. These problems do not go away with surgery and can persist. Studies indicate that 10 - 15% of patients change jobs after a CTS operation.
  

If pain and symptoms return, the release procedure may be repeated.

Reasons for procedure failure include:

• Incomplete release of the ligament
  
• Extensive scarring
  
• Recurrence of the disorder due to underlying medical conditions
  

Patients who had open release surgery appear more likely to require repeat operations compared with those who have had endoscopic surgery.

Reference:

1. http://emedicine.medscape.com/article/822792-followup
   
2. http://health.nytimes.com/health/guides/disease/carpal-tunnel-syndrome/prognosis.html
   
3. http://emedicine.medscape.com/article/327330-followup
   
4. http://www.nlm.nih.gov/medlineplus/ency/article/000433.htm
   
5. http://www.umm.edu/patiented/articles/what_surgical_procedures_carpal_tunnel_syndrome_000034_9.htm