Is carpal tunnel syndrome a slow, chronic, progressive nerve entrapment?

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Highlights

  • Carpal tunnel syndrome (CTS) was more severe in elderly patients than in younger people.

  • The frequency of CTS diagnosis among Neurophysiological Studies performed increased with ageing up to 60 years of age.

  • Bilateral CTS was more severe than when presenting unilaterally.

Abstract

Objective

The aim of this study is to investigate the presenting profile of patients with carpal tunnel syndrome (CTS) at various ages.

Methods

We performed a cross-sectional study of CTS, analysing the correlation between severity and age.

Results

We examined 3108 subjects with CTS, whose frequency increased from 20.9% for the age group 20–29 years to 61.7% for the age group 50–59 years. It remained at almost 50% in people aged over 80 years (49.2%). More than 50% of people younger than 30 years had mild CTS. Severe CTS progressively increased, reaching more than 50% of the CTS diagnoses in people over 80 years. Of the total number of cases, 80.8% of subjects had bilateral CTS. Mild NCS–EMG abnormalities were seen in 74.1% of patients with unilateral involvement, whereas moderate and severe CTS appeared in 70.3% of patients with bilateral involvement.

Conclusion

There was a clear trend of deterioration with advancing years when comparing severity to age.

Significance

CTS seems to be a chronic condition whose signs and symptoms may vary and progress, becoming worse over time.

Introduction

Carpal tunnel syndrome (CTS) is the most frequent mononeuropathy seen in the general population. It results in pain and paraesthesia in the distal median nerve distribution. Sensory symptoms can vary considerably (Bland, 2007, Dumitru and Zwarts, 2001, Mondelli et al., 2001, Becker et al., 2002, Nora et al., 2005, Ibrahim et al., 2012, AAOS, 2007). Pain and paraesthesia are the most common manifestations of CTS (Nora et al., 2005). Autonomic symptoms may also occur (Verghese et al., 2000). Wasting and weakness of the thenar muscles and median innervated lumbricals is seen in severe cases (Meena et al., 2008). The second lumbrical is relatively less affected in severe CTS, as the motor fibres innervating the lumbricals are centrally located in the median nerve (Yates et al., 1981, Verghese et al., 2000).

Although diagnosis of CTS is primarily clinical, a neurophysiological (NCS–EMG) study is the most reliable form of examination to confirm the lesion, and it also provides information on its severity. Furthermore, it also excludes other types of neuropathies (Bland, 2007, Dumitru and Zwarts, 2001, Becker et al., 2002, Kouyoumdjian, 1999, AAOS, 2007, Ibrahim et al., 2012) and is the best objective diagnostic test.

Various underlying conditions such as obesity, diabetes, inflammatory processes and infection may predispose to CTS, in addition to gender and genetic factors (Dumitru and Zwarts, 2001, Becker et al., 2002, Hakim et al., 2002, AAOS, 2007, Ibrahim et al., 2012, MacDermid and Doherty, 2004). However, in many cases there is no identifiable co-morbidity or causal relationship (AAOS, 2007). The few previously conducted CTS studies in elderly people have shown them experiencing worse electrophysiological changes (Kouyoumdjian, 1999, Seror, 1991), although these studies did not analyse the CTS progression over the course of their lifetimes. Therefore, the aim of this study is to investigate the presenting profile of patients with CTS at various ages.

Section snippets

Study design

A cross-sectional study of CTS’s severity was performed in a large sample.

Subjects

A prospective evaluation was conducted of 6317 consecutive patients (12,634 hands) referred to the Clinical Neurophysiology Service of the University Hospital of the Universidade Luterana do Brasil (ULBRA). All patients who underwent NCS–EMG had some symptoms of pain, paraesthesia, hypoaesthesia or weakness in at least one upper limb. NCS–EMG of both upper limbs was performed in all patients from January 2000 to December

Study population

Of the 6317 patients (12,634 hands) referred, 3108 (49.2%) met the electrophysiological criteria for CTS.

Gender and CTS

CTS diagnosis was higher among women in all age groups. The total percentage of cases was 55.3% in female and 28.1% in male patients (p < 0.001) (Table 1).

Age and CTS

Age varied from 20 to 95 years. Fig. 1 shows the CTS frequency and the distribution of electrophysiology tests performed according to age groups. CTS diagnosis progressively increased from 20.9% for the age group 20–29 years, rising to 61.7%

Discussion

This research attempted to define the progress of CTS in patients at various ages. A cross-sectional study was chosen as an indirect way of showing the disease’s progression with age. A better study design to confirm our theory would be that of a cohort study. However, this would be difficult to perform and expensive. In addition, a cohort study could result in delays to CTS treatment, with subsequent clinical deterioration, which is not ethically acceptable. The sample collected involved

Acknowledgement

No grant support.

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