Carpal tunnel syndrome in children is uncommon. Mucopolysaccharidosis is the most common cause of carpal tunnel syndrome in this age group. With new treatment modalities available for mucopolysaccaridoses, the prognosis of the disease has greatly improved. The musculoskeletal manifestations including carpal tunnel syndrome now assume more importance. Early diagnosis and treatment of carpal tunnel syndrome in these children are important to achieve a good outcome. The authors present their experience in the management of children with mucopolysaccharidosis and carpal tunnel syndrome.

Many surgical procedures require intraoperative stimulation of peripheral nerves. Using a pair of conventional bipolar forceps and an anesthetic impulse generator (Stimlocator, Model SL3, B. Braun Australia Pty Ltd, Australia), we have developed a simple, effective, and inexpensive alternative to standard nerve stimulation devices that enables the accurate localization of motor fascicles intraoperatively. Bipolar forceps provide better control than a monopolar electrode, as the current generated across the nerve fibers generates an action potential that is then propagated down the axon. This inexpensive and reusable device is routinely used at Royal Children's Hospital, Melbourne, and its efficacy and ease of use has been demonstrated over a long period.

ANZ Journal of SurgeryVolume 76, Issue 1-2 p. 6-8 AVOID LONDON, 7 JULY 2005 Geoff Donald BSc FRACS (Orth), Geoff Donald BSc FRACS (Orth)Search for more papers by this authorGuy Dowling BSc (Hons) FRACS (Plas), Guy Dowling BSc (Hons) FRACS (Plas)Search for more papers by this author Geoff Donald BSc FRACS (Orth), Geoff Donald BSc FRACS (Orth)Search for more papers by this authorGuy Dowling BSc (Hons) FRACS (Plas), Guy Dowling BSc (Hons) FRACS (Plas)Search for more papers by this author First published: 16 February 2006 https://doi.org/10.1111/j.1445-2197.2006.03652.x Guy Dowling is a plastic and reconstructive surgeon with a special interest in congenital hand anomalies. He has returned to Melbourne to take up a consultant position at Southern Health. Guy gratefully acknowledges the financial assistance provided by a RACS scholarship during his fellowship. Geoff Donald is an orthopaedic surgeon trained in Sydney. He has a special interest in paediatric orthopaedics, specifically lower limb reconstruction. Geoff returns to Australia to take up a consultant position at the Royal Children's Hospital, Brisbane. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Volume76, Issue1-2January 2006Pages 6-8 RelatedInformation

BACKGROUND:Arterial occlusion in infants, although uncommon, is usually an iatrogenic event associated with arterial vascular access. Most common in the upper limb, the consequences of iatrogenic arterial occlusion may be gangrene and limb loss. Even if there is adequate collateral flow and limb loss is avoided, long-term growth disturbances may be seen. There are few published data to guide the management of arterial occlusion in premature or sick infants. In general, there is agreement regarding the importance of early diagnosis and the reestablishment of limb perfusion with the fewest risks, but the optimal choice and timing of treatment modalities remain unknown. METHODS:This article examines the authors' experiences at the Royal Children's Hospital, Melbourne, and provides their algorithm for the management of this complex iatrogenic disease. RESULTS:The management algorithm has successfully treated 11 limbs in 11 patients with arterial vascular access-associated thrombosis over the period 1995 to 2003, with no instances of limb loss. Five of these patients required surgical intervention. CONCLUSIONS:The authors recommend a multidisciplinary approach involving plastic surgeons and hematologists for all cases of suspected or confirmed arterial thrombosis. A consensus algorithm that determines the role of heparin, thrombolysis, and acute surgical interventions, and the sequence of such interventions, is useful in providing the framework of therapy. The early recognition of the limb at risk is a key factor in obtaining a successful outcome.