Antonio Mondriguez-Gonzalez, MD
Resident
Shirley Ryan Ability Lab
Chicago, Illinois, United States
Shyam Maisuria, BS
Medical Student
Frank H. Netter MD School of Medicine
Hamden, Connecticut, United States
Colin K. Franz, MD/PhD
Associate Professor
Shirley Ryan AbilityLab
Chicago, Illinois, United States
Carpal Tunnel Syndrome
Case Description:
A 55-year-old right-handed female with prior carpal tunnel syndrome presented with worsening right thumb weakness, numbness, tingling in the first three fingers, and pain despite wearing wrist splints. Her thumb’s active range of motion and fine motor skills were severely impaired. Physical exam was notable for pronounced right thenar atrophy with weakness in bilateral thumb abduction and opposition, more so on the right. Initial electrodiagnostic (EDX) exam indicated bilateral median mononeuropathy, with severe motor axon loss on the right and sensory demyelination on the left. Underwent right carpal tunnel endoscopic release with post-op therapy and six months of weekly 1-hour bouts of therapeutic electrical stimulation (TES) with transcutaneous adaptation of prior TES protocol by Dr. K. Ming Chan and colleagues. Eight months later, she showed markedly improved right thumb strength, fine motor skills, and right median motor and sensory nerve amplitudes, followed by normal median EDX values four years later.
Discussions:
A randomized clinical trial (RCT) of 21 patients with carpal tunnel release showed that those who received a single, 1-hour session of TES showed accelerated recovery, with greater EDX improvements by 1-year post-op compared to those undergoing surgery alone. The present case differs from the RCT in its TES approach. We applied TES non-invasively with 1-hour sessions per week for six months using transcutaneous electrodes, whereas the RCT used percutaneous wires implanted on the median nerve intra-operatively and later removed. The method described in the RCT is challenging to implement and may not be feasible due to the increased use of minimally invasive techniques.
Conclusions:
This case highlights a dramatic recovery from severe axonal carpal tunnel syndrome with post-op non-invasive TES. A less invasive, transcutaneous approach as an adjunct to carpal tunnel release surgery is highly desirable. To confirm these findings, an RCT is essential.
