JKSSH Journal of the Korean Society for Surgery of the Hand J Korean Soc Surg Hand 1598-3889 2234-0998 The Korean Society for Surgery of the Hand 10.12790/jkssh.2015.20.3.89 jkssh-20-89 Original Article Carpal Tunnel Syndrome in Patients Undergoing Long-Term Hemodialysis Therapy: Clinical Characteristics and Results of Surgical Treatment ParkHojin LeeDae Sung YunTae Kyoung AhnDuck Sun Department of Plastic Surgery and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea Correspondence to: Duck Sun Ahn Department of Plastic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea TEL: +82-2-920-5368 FAX: +82-2-922-7437 E-mail: dsahn@korea.ac.kr 09 2015 11 09 2015 203 89 95 12072015 10082015 12082015 13082015 Copyright © 2015 Korean Ophthalmological Society 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose:

Carpal tunnel syndrome (CTS) has become increasingly recognized as a complication of long-term hemodialysis. This study evaluated the clinical characteristics and compared the results of carpal tunnel release for CTS patients with or without hemodialysis.

 Methods:

We retrospectively reviewed the clinical characteristics and surgical outcomes of 49 chronic hemodialysis patients with 83 CTS hands. Also, 100 patients were selected for the control group. Patient characteristics, accompanying systemic conditions, operative outcomes were compared.

 Results:

In hemodialysis group, the mean age and hemodialysis duration were 59.5±10.5 years and 4.1±2.5 years, respectively. Of the 83 hands with CTS, 45 (54.2%) had arteriovenous fistulas, while 38 (45.7%) did not (p=0.02). Most (81.6%) of the patients reported symptom improvement after surgical treatment, and the remaining patients (18.4%) reported persistent and recurrent symptoms. Rates of remaining symptoms and reoperations were significantly higher in the CTS patients with hemodialysis group.

 Conclusion:

Majority of CTS patients with hemodialysis have much improved after transverse carpal ligament release. However, they showed higher recurrence than idiopathic CTS patients. In recurrent patients, use of the extended carpal tunnel release is effective in symptom relief.

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Patient inclusion and exclusion criteria. 49 chronic renal failure patients who were on hemodialysis and followed-up more than 1 year were included in hemodialysis group. Among 3,275 patients who were without chronic renal failure and diagnosed with carpal tunnel syndrome, 100 was selected randomly and categorized as the “Without dialysis group”.

Associated systemic conditions

Associated systemic conditions Cases
Diabetes 9
Hypertension 24
Depression, anxiety 5
Atrial fibrillation 7
Chronic heart failure 19
Unstable angina 15
Tuberculosis 4
Chronic hepatitis (hepatitis B and C) 12
Liver cirrhosis 4
Hypothyroidism 4
Cerebral vascular accident 4
Trigger finger 10
Rheumatoid arthritis 2
Raynaud phenomenon 2
De Quervain tenosynovitis 2
Cervical radiculopathy 1
Cubital tunnel syndrome 1
Amyloidosis 2
Ankylosing spondylitis 1
Malignant cancer 2

Concomitant underlying diseases in carpal tunnel syndrome patients with chronic renal failure are presented.

Correlation between fistula side and prevalence of CTS (significant difference, p<0.05)

Variable AVF (+) AVF (-) Total
CTS (+) 45 35 80
CTS (-) 4 14 18
Total 49 49 98

Carpal tunnel syndrome on the fistula side was correlated with CTS prevalence in our study. The hand of fistula side had higher rate of carpal tunnel syndrome than non-fistula side.

Chi-square test, p=0.02.

CTS, carpal tunnel syndrome; AVF, arteriovenous fistula.

Comparison between groups (significant difference, p<0.05)

Characteristic Hemodialysis group (n=49) Control group (n=100) p-value
Age (yr) 59.5±10.5 57.8±11.4 0.849
Male:female 18:31 32:68 0.584
EMG severity (hands) (moderate:evere) 21:62 55:112 0.245
Bilateral CTS (n) 34 (69.4) 67 (67.0) 0.853
Follow-up periods (yr) 4.7±1.3 5.2±2.1 0.738
Peripheral polyneuropathy (n) 14 (28.6) 21 (21.0) 0.677
DM (n) 9 (18.4) 17 (17.0) 0.814
Accompanying trigger finger (n) 10 (20.4) 14 (14.0) 0.347
Persistent or recurrent symptoms (n) 9 (18.4) 4 (4.0) 0.02
Secondary operation (n) 6 (12.2) 3 (3.0) 0.03

Values are presented as mean±standard deviation or number (%).

There was no statistical significance in the prevalence of bilateral CTS, peripheral polyneuropathy, D), and trigger finger between the two groups.

The rate of persistent or recurrent symptoms and secondary operation in the hemodialysis group was higher than that in control group.

EMG, electromyography; CTS, carpal tunnel syndrome; DM, diabetes mellitus.