Reynaud's phenomenon and entrapment neuropathies

Autonomic dysfunction in idiopathic carpal tunnel syndrome

While the sensorimotor features of carpal tunnel syndrome (CTS) are well known, a prospective, systematic study of autonomic disturbances in CTS is lacking. Of 139 limbs with CTS (76 patients), autonomic symptoms were reported in 76 (47 patients). Of these, 59% consisted of swelling of the fingers, 39% dry palms, 33% Raynaud's phenomenon, and 32% blanching of the hand. Sympathetic skin response (SSR) had a sensitivity/specificity ratio of 34/89% in CTS with autonomic symptoms. The presence of autonomic disturbances was significantly associated with female gender (odds ratio 4.06, 95% CI 1.5-11.4, P = 0.007), SSR abnormalities (odds ratio 4.3, 95% CI 1. 6-11.4, P = 0.003), and severity of electromyographic findings (odds ratio 1.8, 95% CI 1-3.3, P = 0.04) but not age, duration of disease, or clinical severity in a binary logistic regression model. Autonomic disturbances are common (55%) in CTS, occurring with increasing severity of electrophysiologic findings.