Is carpal tunnel syndrome surgery useful in patients with diabetes or autoimmune polyneuropathies?

Abstract

In the neurological ‘out‐patient’ department, focused on neuropathies, we have to deal with two common diseases: diabetic neuropathy and autoimmune neuropathies. Carpal tunnel syndrome is the most frequent neurological syndrome. It is difficult to assess if, in a diffuse peripheral nerve involvement or in systemic condition that may involve nerves, as diabetes, an entrapment condition is a distinct entity, a co‐morbidity condition, or expression of a “locus minor resistentiae.” In clinical practice it is difficult to answer these questions: in autoimmune neuropathy patients and in diabetic patients, should we surgically treat nerve entrapment? Recently we provided evidence that a mechanical condition around the nerve, typical of the entrapment region, does not enhance autoimmune aggression in CIDP. Therefore, in CIDP patients a true entrapment, neurophysiologically demonstrated, could be a concomitant pathology and if a severe and persistent entrapment worsens functional deficit and symptoms, a surgical decompression could be useful. There is evidence that diabetic patients operated for carpal tunnel syndrome have the same post surgery evolution than non‐diabetic patients. In conclusion, in autoimmune neuropathies and diabetic patients, the physician should strongly consider the possibility of surgery.