Acute Carpal Tunnel Syndrome Requires Immediate Surgery
Many people are familiar with carpal tunnel syndrome (CTS). Most often the condition is chronic with a gradual onset of pain, numbness, and tingling of the fingers, palm, and/or wrist. But sudden CTS can occur as a result of bone fracture, infection, snake bite, or other trauma.

Sudden, severe symptoms of CTS that develop over the course of a few hours (rather than weeks to months) is referred to as acute CTS. A rapid rise in pressure occurs inside the carpal tunnel.

Symptoms develop as a result of compression of the nerve from blood (hemorrhage), snake venom, tumor, or other fluid inside the compartment. Blood clots, bone fractures and/or dislocation, and burn or thermal injuries can also lead to acute CTS.

In this review study, Dr. K. A. Schnetzler, an orthopedic surgeon reports that most cases of acute CTS are caused by uncommon disorders and injuries. Immediate medical attention is required. Surgery to relieve pressure on the median nerve restores blood flow to the area needed to preserve normal nerve function. This procedure is called surgical decompression.

A careful diagnosis is needed to distinguish between nerve contusion versus acute nerve compression. Nerve contusion (bruising) may only require rest and close follow-up. Urgent surgical treatment is more likely for rapid elevation of pressure from acute CTS.

Dr. Schnetzler describes the desired treatment protocol for acute CTS. Early nonoperative emergency measures such as elevation and support of the hand, wrist, and forearm are discussed. Measuring carpal tunnel pressures can help direct the timing of surgical intervention. Length and placement of the surgical incision is suggested but left up to the surgeon's preference.

Results are best when surgery is done within the first few hours of trauma. Complete return of function is more likely when release occurs in the first 12 hours. Delayed diagnosis and intervention leads to delayed return of function.
Kent A. Schnetzler, MD. Acute Carpal Tunnel Syndrome. In Journal of the American Academy of Orthopaedic Surgeons. May 2008. Vol. 16. No. 5. Pp. 276-282.