Carpal Tunnel Syndrome in Childhood: Report of a Case.

Wasting of the thenar muscles secondary to traumatic or degenerative lesions around the wristjoint has been recognised for over 100 years. In 1863 Sir James Paget described a patient whose median nerve was compressed by callus after a fracture at the wrist. Many examples of median nerve compression have since been reported where the capacity of the carpal tunnel has been reduced by osseous protrusions from the walls or swelling of its soft-tissue content (British Medical Journal 1961). In 1913 Marie and Foix reported a post-mortem examination of an aged hemiplegic patient with bilateral thenar wasting and, after dissection and microscopy of the brachial plexus and spinal cord, showed that the median nerve was compressed beneath the anterior carpal retinaculum. They could not be sure of the exact mechanism of the compression, “ strangulation or trauma,” but suggested that division of the anterior carpal retinaculum might arrest the progress of the condition if carried out early enough. Thirty years passed before Cannon and Love (1946) demonstrated conclusively that carpal tunnel decompression dramatically relieved the pain and paraesthesiae in patients with objective evidence of median nerve compression. In 1947 Brain, Wright and Wilkinson showed that compression of the median nerve in the carpal tunnel could occur spontaneously in the absence of any obvious reduction in the capacity of the tunnel or increase in volume of its contents. The pain, tingling and sensory impairment occurring in the hands of middle-aged women with thenar wasting, is now considered to be due to primary or spontaneous compression in the majority of cases. The condition is less common in men, is unusual before middle age, and is almost unknown in childhood. There appears to be only one account of median nerve compression occurring in children, that of Martin and Masse who recorded three cases in 1958. Personal enquiries from a number of leading neurologists and others interested in the condition have failed to bring any further cases to light. All three of the children reported by Martin and Masse suffered from recurrent attacks of severe pain in the hand. The first, a girl aged six, had symptoms which failed to respond to