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LETTER TO THE EDITOR

Exacerbation of Carpal Tunnel Syndrome Under Treatment with Valdecoxib

Institute of Anaesthesia; Kantonsspital; Lucerne, Switzerland; wruppen{at}freesurf.ch

To the Editor:

Multiple studies in patients with osteoarthritis, rheumatoid arthritis, and acute pain have now confirmed that the clinical efficacy of COX-2-specific inhibitors is similar to that of conventional NSAIDs (1–3). We treated a 40-year-old patient with knee contusion with 40 mg valdecoxib once a day. Twenty-four hours after beginning therapy, the patient developed a massive exacerbation of a preexisting carpal tunnel syndrome (CTS) with the typical signs (4) previously known by the patient.

Because of suspicion of developing a valdecoxib-associated edema in the carpal arch, the therapy was replaced with ibuprofen 400 mg three times a day. No conservative management with splinting was initiated. Within another 12 hours the CTS signs and symptoms disappeared and the patient's knee remained pain free.

This case raises the suspicion that a COX-2 inhibitor (valdecoxib) treatment- associated edema may have aggravated a preexisting condition of CTS. The withdrawal of the COX-2 inhibitor was probably relevant for the relief of the CTS.

The effect of nonsteroidal antiinflammatory medications on carpal tunnel syndrome have not been well studied (5), but a trial of these drugs is suggested.

References

1. Barden J, Edwards JE, McQuay HJ, Moore RA. Oral valdecoxib and injected parecoxib for acute postoperative pain: a quantitative systematic review. BMC Anesthesiol 2003;3:1.[Medline]
2. Gilron I, Milne B, Hong M. Cyclooxygenase-2 inhibitors in postoperative pain management: current evidence and future directions. Anesthesiology 2003;99:1198–208.[Web of Science][Medline]
3. Reuben SS, Connelly NR. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg 2000;91:1221–5.[Abstract/Free Full Text]
4. Katz JN, Simmons BP. Clinical practice: carpal tunnel syndrome. N Engl J Med 2002;346:1807–12.[Free Full Text]
5. Carder KR, Weston WL. Rofecoxib-induced instant aquagenic wrinkling of the palms. Pediatr Dermatol 2002;19:353–5.[Web of Science][Medline]

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