Surgical management of carpal tunnel syndrome in neurosurgery practice in Ethiopia and review of literature.

Carpal tunnel compression of the median nerve is a common condition with an estimated incidence of 0.1% to 10% and a direct medical cost of above dollars 1 billion per year in the USA. Between the years 1995 to 2002, 28 cases, 6 (21.4%) males and 22 (87.6%) females of mild to severe forms of carpal tunnel syndrome (CTS) were seen and treated by the author in Tikur Anbessa Hospital (TAH) Neurosurgery Unit and a private hospital in Addis Ababa. Of the 28 cases, 22 (87.6%) patients, 7/22 (31.8%) mild and 15/22 (68.2%) severe forms, were surgically treated with the open surgery method. The male to female ratio was 1:3.7 and the age range 28-52 years, with a mean of 40.6 +/- 7.2 and the Confidence Interval of the mean 37.7-43.0; a median of 40 yrs and a mode of 40. Fifty percent of the cases were below 35 years and 75% below 46.75 years. The duration of illness was from 6 months to 8 years. There were 8/28 (28.6%) females with bilateral conditions. All the males had right sided carpal tunnel syndrome; the right hands were more involved in 23 (63.9%) cases while left hands only in 13 (36.1%) patients. All 22 patients were much relieved of the aching pains in the respective hands 3-5 days postoperatively and by 3 months 5 patients, the only ones who reported for follow-up, showed much reduced numbness and paraesthesiae with fairly good gripping capacity of the operated hands, though wasting and atrophy of the thenar eminences persisted requiring adequate exercise and early physiotherapy. There is no recurrence or worsening of the illness reported. Carpal tunnel syndrome is a treatable condition. It is stressed that an open surgery, required division of the flexor retinaculium and palmar aponeurosis extending to distal base attachment of the thenar eminence in the hand, is essential for the definitive treatment and to avoid any recurrence. Open surgery is easy and cheap and can be done by the general surgeon with a good anatomical knowledge of the hand.