Carpal Tunnel Syndrome Accompanying Radial Dysplasia Due to Thalidomide Embryopathy

Abstract

We performed endoscopic carpal tunnel release in four hands in three patients suffering from radial dysplasia due to thalidomide embryopathy. Carpal canal pressure measurements results confirmed the diagnoses. All operations were successfully performed and resulted in no complications. Tingling sensation and sensory disturbances of the hands subsided.

Late‐onset neurological symptoms in thalidomide‐exposed subjects: a study of an Australasian cohort

“…Rather, the development of new symptoms in subjects can be explained by (i) compressive neuropathies, due to, for example, median nerve compression at the wrist, and (ii) compensatory postures employed to perform tasks of daily living. The former is likely a reflection of the overuse and abnormal postures required to accommodate the disability, poor mobility arising from the limb deformities and narrowing of the carpal tunnel by musculoskeletal defects .…”

“…The chance of developing median nerve compression at the wrist is probably greater in thalidomide‐affected subjects because the musculoskeletal deformities may lead to further narrowing of the carpal tunnel, and there is overuse of the hand to compensate for other limb deformities. That carpal tunnel syndrome can occur in the presence of radial dysplasia has been documented by the response to decompressive surgery . Median nerve compression at the wrist is recognized as a common occurrence in wheelchair users who propel themselves .…”

Middle-aged individuals with thalidomide embryopathy have undergone few surgical limb procedures and demonstrate a high degree of physical independence

“…The finding that surgical procedures on the upper extremities were more common than lower limb surgeries may be due to the higher prevalence of limb deficiencies and other congenital malformations of the upper limbs [ 4 , 5 , 9 ]. Further, surgeries of the upper extremities later in life, related to overuse or a modified movement pattern of arms/hands, probably also added to this number [ 16 ]. In TE, the thumbs have various malformations; while some TE have three phalangeal thumbs, other TE might have no thumb at all but five or fewer parallel fingers, without any opportunity for thumb opposition movements [ 9 ].…”

“…Carpal tunnel release was a relatively frequent procedure in this cohort and all these procedures were performed after the age of 18 years. In a recent report from Japan, a high frequency of carpal tunnel syndrome (CTS) in individuals with TE has been noted [ 16 ]. The absence, hypoplasia or dysplasia of the radius is a common malformation in the upper extremities of TE individuals [ 4 ] and a subsequent wrist deformity might cause compression of the median nerve at wrist level.…”

Commentary on Markiewicz et al. Age-related changes in patients with upper limb thalidomide embryopathy in the United Kingdom

“…Besides the functional impairment caused by their limb difference (i.e. phocomelia, radial longitudinal deficiency or RLD), patients with thalidomide embryopathy (TE) remain particularly prone to develop compressive neuropathies such as carpal tunnel syndrome (Oshima et al., 2006). Other sensory neuropathies, radiculopathies and cervical myelopathy due to axonal nerve dysfunction have been described as well (Nicotra et al., 2016).…”