This week’s New York Times article on Carpal Tunnel Syndrome highlighted the importance of this clinical condition. This is an entrapment problem of the median nerve at the wrist level from pain and swelling of the flexor tendons traveling through the carpal tunnel. The entrapment neuropathy of the median nerve gives rise to pain, abnormal sensations in the first three digits and weakness in function of the thumb muscles supplied by the median nerve. It is estimated at 4-10 million have carpaltunnelsyndrome.
A study performed to analyse 215 adults with Carpal Tunnel Syndrome based on symptoms and abnormal electrodiagnostic findings showed that electrodiagnostic findings and patient CTS-related symptoms and function appear to be independent measures. Patient symptom severity analysis included 11 items that assessed pain, numbness, and weakness. Patients also rated their average hand and wristpain in the last month. Functional limitations were analysed after controlling for potentially confounding variables including age, sex, body mass index, symptom duration, depression, somatization, and pain -related catastrophizing. (Chan L. Turner JA. Comstock BA. Levenson LM. Hollingworth W. Heagerty PJ. Kliot M. Jarvik JG. The relationship between electrodiagnostic findings and patient symptoms and function incarpaltunnelsyndrome.Archives of Physical Medicine & Rehabilitation. 88(1):19-24, 2007 Jan.)
Another study to determine what proportion of patients referred with a clinical suspicion of carpaltunnelsyndrome (CTS) have negative electrodiagnostic studies and identify their clinical diagnoses and to identify clinical features that predict the outcome of electrodiagnostic testing in patients referred with suspected CTS. Of the 348 patients enrolled, 179 (51.4%) had electrodiagnostic studies that were inconsistent with a diagnosis of CTS. Twenty-seven patients (15.1%) had other electrodiagnostic abnormalities (eg, ulnar neuropathy, cervical radiculopathy), whereas the remaining 152 (84.9%) patients had studies within normal limits. Seventy-one patients (46.7%) with normal studies were diagnosed with musculoskeletal disorders, with myofascial pain and musculotendinous strain being most common. Positive electrodiagnostic testing for CTS were more correlated with gender, duration of symptoms, night symptoms, sensory symptoms, wristpain, neck pain, pinprick sensation, abductor pollicis brevis strength, and thenar bulk. Therefore, m any patients referred to an electrodiagnostic laboratory with a clinical suspicion of CTS have other diagnoses, most commonly musculoskeletal disorders. Because these various conditions may be mistaken for CTS, the electrodiagnostic evaluation is therefore an important diagnostic tool. (Lo JK. Finestone HM. Gilbert K. Woodbury MG. Community-based referrals for electrodiagnostic studies in patients with possiblecarpaltunnelsyndrome: what is the diagnosis?Archives of Physical Medicine & Rehabilitation. 83(5):598-603, 2002).
Even with or without positive electrodiagnostic studies for carpal tunnel syndrome, pain in the wrist and hand should be treated conservatively before surgery is resorted to for release of the median nerve at the carpal tunnel level. Many patients do not do well even after carpal tunnel release surgery or that the problem may recur again. This is because the associated musculoskeletal problems were not diagnosed or treated. Without taking care of the associated muscle tightness and or spasm in the muscles of the neck, shoulder and arm, the carpal tunnel symptoms will be long lasting and recur even if adequate treatments were applied to the carpal tunnel level.