E Polykandriotis1, W Premm, R E Horch. 1. 1Department of Plastic and Hand Surgery, University of Erlangen Medical Center, Erlangen, Germany.
Abstract
BACKGROUND: The carpal tunnel syndrome (CTS) is by far the most frequent compression neuropathy and encompasses 45% of all non-traumatic nerve lesions. Women are affected twice as often as men and manifestation usually occurs over the age of 30; 76% of all patients become symptomatic between the age of 40-70 years. In young adults typical diagnostic clues suggestive of a CTS, may be absent leading to misdiagnosis and late treatment. PATIENTS AND METHODS: 30 patients suffering from CTS were subdivided in 2 groups according to age. Patients under the age of 35 were allocated in group A whereas patients over 35 years old were included in group B. The two groups were compared to each other in terms of demographics, clinical signs, electrodiagnosis and ultrasonography of the carpal tunnel. All patients were subjected to a decompression procedure of the median nerve and postoperative alleviation of the symptoms was considered as confirmation of the presence of a CTS. Two characteristic clinical cases of young adults suffering from CTS are demonstrated. RESULTS: The female to male ratio was higher in group A (7:1) than in group B (3:1). Only two (25%) of the patients in group A had a positive Tinel sign but in 7 patients (87.5%) the Phalen test could be readily evoked. In group B a Tinel sign was present in 45% whereas a positive Phalen test was present in 86%. A positive Tinel sign was associated with a distal motor latency beyond 4 ms in the two patients from group A. A distal motor latency was present in 95.2% of the patients in group B. In ultrasound there was an average decrease of 0.557 mm in the thickness of the median nerve throughout its course in the carpal tunnel in group B. In group A, ultrasonography revealed no significant changes in nerve diameter. DISCUSSION: The value of electrophysiological studies as a diagnostic tool in CTS still remains controversial. In young adults phenomena leading to impaired nerve conduction like axonal demyelination of the median nerve might occur later due to a higher regenerative potential. However, symptomatic patients may be strongly hindered in their everyday activities and occupation and should be readily referred to a hand specialist in spite of a negative work-up.
BACKGROUND: The carpal tunnel syndrome (CTS) is by far the most frequent compression neuropathy and encompasses 45% of all non-traumatic nerve lesions. Women are affected twice as often as men and manifestation usually occurs over the age of 30; 76% of all patients become symptomatic between the age of 40-70 years. In young adults typical diagnostic clues suggestive of a CTS, may be absent leading to misdiagnosis and late treatment. PATIENTS AND METHODS: 30 patients suffering from CTS were subdivided in 2 groups according to age. Patients under the age of 35 were allocated in group A whereas patients over 35 years old were included in group B. The two groups were compared to each other in terms of demographics, clinical signs, electrodiagnosis and ultrasonography of the carpal tunnel. All patients were subjected to a decompression procedure of the median nerve and postoperative alleviation of the symptoms was considered as confirmation of the presence of a CTS. Two characteristic clinical cases of young adults suffering from CTS are demonstrated. RESULTS: The female to male ratio was higher in group A (7:1) than in group B (3:1). Only two (25%) of the patients in group A had a positive Tinel sign but in 7 patients (87.5%) the Phalen test could be readily evoked. In group B a Tinel sign was present in 45% whereas a positive Phalen test was present in 86%. A positive Tinel sign was associated with a distal motor latency beyond 4 ms in the two patients from group A. A distal motor latency was present in 95.2% of the patients in group B. In ultrasound there was an average decrease of 0.557 mm in the thickness of the median nerve throughout its course in the carpal tunnel in group B. In group A, ultrasonography revealed no significant changes in nerve diameter. DISCUSSION: The value of electrophysiological studies as a diagnostic tool in CTS still remains controversial. In young adults phenomena leading to impaired nerve conduction like axonal demyelination of the median nerve might occur later due to a higher regenerative potential. However, symptomatic patients may be strongly hindered in their everyday activities and occupation and should be readily referred to a hand specialist in spite of a negative work-up.
Authors: Benjamin S H Bryant; Kathleen Marsh; Ian R Smithson; Michael D Wigton; T David Luo; Linda Chao; Ethan Wiesler Journal: Hand (N Y) Date: 2021-01-19