Complex Regional Pain Syndrome (CRPS) of the upper limb represents a heterogeneous clinical condition with an incompletely understood pathophysiology and often unsatisfactory treatment outcomes. Mechanical contributors within the carpal tunnel, including impaired neural and tendinous gliding, have recently been proposed as a potential factor in a subset of patients presenting with CRPS-like symptoms, conceptualized as ‘irritative carpal tunnel syndrome (ICTS)’. The clinical impact of this hypothesis remains under investigation.

This study aimed to explore clinical and functional outcomes following targeted carpal tunnel treatment, including corticosteroid injection and transverse carpal ligament release, in patients presenting with CRPS-like symptoms and clinical features suggestive of irritative carpal tunnel syndrome.

A retrospective cohort of 26 patients presenting with CRPS-like symptoms after upper limb trauma or prior surgery between June 2021 and April 2024 was evaluated; 2 patients were totally lost to follow-up, leaving an evaluation of 24 patients. All patients fulfilled the Budapest criteria for CRPS and demonstrated clinical features suggestive of the irritative carpal tunnel syndrome. Patients were managed with corticosteroid injection and/or surgical release of the transverse carpal ligament based on clinical presentation. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, the QuickDASH questionnaire, and patient satisfaction.

Twenty-one patients underwent surgical transverse carpal ligament release, while three achieved sustained improvement following corticosteroid injection alone. Among patients completing full outcome measures (n = 18), mean VAS pain scores decreased from 70/100 pre-treatment to 11/100 post-treatment, with 56% of respondents reporting complete pain relief (p < 0.001). Mean QuickDASH scores (n = 14) improved by 38 points, from 59/100 to 21/100 (p < 0.001). Overall patient satisfaction was high, with 94% of respondents reporting a satisfaction score ≥8/10. No major treatment-related complications were observed.

Carpal tunnel-targeted treatment was associated with substantial pain reduction and functional improvement in a subset of patients presenting with CRPS-like symptoms and clinical features suggestive of irritative carpal tunnel syndrome. These findings support the potential role of mechanical contributors within the carpal tunnel in the heterogeneous clinical spectrum of CRPS and warrant further prospective investigation.