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