Bilateral carpal tunnel syndrome in a child with type 1 diabetes mellitus.

摘要

Carpal tunnel syndrome (CTS) is a collection of symptoms associated with compression of the median nerve at the wrist. It is extremely uncommon in pediatric age group. An 11-year-old boy, a known case of type diabetes mellitus (DM) since the age of six years on insulin with poor control, presented with complaints of weakness of both hands and burning, tingling, numbness and pricking in the hands more so in the first three digits. Symptoms worsen with the movements of wrist. On examination, he showed partial weakness in both hands. Thenar atrophy was not present. Phallen's and Tinel's tests were positive bilaterally. The other system examination was normal. Laboratory test: Blood glucose was 411 mg/dl and HbAlc was 10.9% (normal, 3.5-6.9%). Neurophysiologic studies showed bilaterally prolonged median motor distal latency, slowing of sensory nerve conduction velocity with normal amplitude bilaterally in the wrist segment. Prolonged median nerve sensory peak latency compared to sensory peak latency of ulnar nerve was observed with stimulation at the ring finger compared to sensory peak latency of the ulnar nerve [Figure 1, Tables 1 and 2]. These findings were consistent with bilateral moderate CTS. Therefore, carpal tunnel surgery was not advised, instead, non-steroidal anti-inflammatory medications and activity modification were suggested as the initial treatment.