Brief Alerts
Carpal Tunnel Syndrome
Sources: Padua L, et al. Multiperspective follow-up of untreated carpal tunnel syndrome: A multicenter study. Neurology. 2001;56:1459-1466. Wong SM, et al. Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome. Neurology. 2001;56:1565-1567. Stevens JC, et al. The frequency of carpal tunnel syndrome in computer users at a medical facility. Neurology. 2001;56:1568-1570.
First described by Pierre Marie and Charles Foix in 1913 (Rev Neurol. 1913;26:647-649), carpal tunnel syndrome (CTS) is the most common abnormality seen in electromyography laboratories across the United States. Multiple treatment modalities exist, including steroids, orally or by injection, the latter first reported by Phalen and Kendrick in 1957 (JAMA. 1957;164:524-530). How well do they compare?
Among 60 CTS patients prospectively enrolled, 30 were randomized to local injection of 15 mg methylprednisolone acetate vs. placebo, and 30 to oral prednisolone 25 mg daily for 10 days vs. placebo. Both active treatment groups significantly improved their global symptom score (GSS) at 2 and 8 weeks, but only steroid injection showed significant GSS improvement at 12 weeks (Herskovitz S, et al. Neurology. 1995;45: 1923-1925). No significant side effects were seen in either group. Steroids work, and a single local injection is better than an oral 10-day course.
Is CTS associated with computer use? Certainly, if you ask many litigation lawyers. However, among 257 of 314 employees identified as frequent computer users who participated in a survey, 181 (70%) reported no CTS symptomatology. Of the remaining 76, 70 were interviewed. Twenty-seven were classified as CTS, 18 possible, and 9 definite. Overall, 10.5% met clinical criteria for CTS which was confirmed by nerve conduction studies in 3.5%. These percentages are comparable to those of the general population. Will this ease the dockets? Wish that it were so!
Lastly, under "why did this merit publication as a full article, and with CME credit to boot," we learn that CTS improves spontaneously. Among 274 hands with idiopathic CTS, spontaneous resolution was associated, surprisingly, with more severe initial symptomatology, as well as younger age, and short duration of symptoms. Milder initial impairment, bilateral baseline symptoms, and positive Phalen sign predicted a poor prognosis. The findings are interesting but this report will not change treatment practices for CTS as they present to your office. It will be a boon to disability lawyers and their clients. A letter to the editor would have sufficed. —Michael Rubin
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