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

Nilgun Selcuk Duru¹, Hurtan Acar², Semih Ayta³, Murat Elevli³,  
¹ Department of Pediatric, Haseki Education and Research Hospital, Istanbul, Turkey
² Department of Neurology,Haseki Education and Research Hospital, Istanbul, Turkey
³ Pediatric Neurology Unit, Haseki Education and Research Hospital, Istanbul, Turkey

Correspondence Address:
Nilgun Selcuk Duru
Department of Pediatric, Haseki Education and Research Hospital, Istanbul
Turkey

Full Text

Sir,

Carpal tunnel syndrome (CTS) is a collection of symptoms associated with compression of the median nerve at the wrist. [1] 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 HbA1c 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], [Table 1] and [Table 2]. These findings were consistent with bilateral moderate CTS. [2] Therefore, carpal tunnel surgery was not advised, instead, non-steroidal anti-inflammatory medications and activity modification were suggested as the initial treatment.

Carpal tunnel syndrome in patients with type 1 diabetes is an extremely rare condition in children and adolescents. In fact, only one case has been described till date. [3] The prevalence of CTS increases with the duration of diabetes. [1],[4] It has been suggested that diabetic polyneuropathy may cause endoneural ischemia and the median nerves become more susceptible to pressure. However, our patient presented with bilateral CTS only without polyneuropathy. Motor and sensory conduction studies were normal in our patient [Figure 1]. Other suggested pathophysiological mechanisms included increasing glycosylation of collagen and fibrosis, or thickening of synovium within the carpal tunnel. [1],[3]

In conclusion, this case demonstrates that the clinician must be alert to the possible diagnosis of CTS in children or adolescent with DM. Early diagnosis and treatment of CTS in these children is important to alleviate symptoms and improve living conditions.

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