High incidence of absent nerve conduction in older patients with bilateral carpal tunnel syndrome

Ultrasonography of carpal tunnel syndrome: clinical significance and limitations in elderly patients

OBJECTIVE

Carpal tunnel syndrome (CTS) severity increases with age. Ultrasonographic measurement of the median nerve cross-sectional area (CSA) is an additional or complementary method for CTS diagnosis. The present study was aimed to investigate the diagnostic significance of median nerve CSA in various age groups of CTS patients.

METHODS

The subjects were patients with electrophysiologically confirmed CTS and age-matched controls. Sonographic measurements of the median nerve CSA were performed.

RESULTS

A total of 279 hands of 175 patients with CTS and 50 normal hands were examined. CSA was correlated with distal motor and sensory latencies of the median nerve and severity of CTS. CTS severity increased with age, particularly in patients over 80; however, their median nerve CSA was not enlarged regardless of their high severity of CTS.

CONCLUSION

Although the median nerve CSA is a useful diagnostic measurement for CTS, it should be emphasized that its diagnostic significance might be limited in aged patients. In particular, in very elderly patients, careful evaluation of CTS severity is necessary.

Effect of age on subjective complaints and objective severity of carpal tunnel syndrome: prospective study

OBJECTIVES

Older patients with carpal tunnel syndrome who are resistant to conservative treatment often have a less than satisfactory outcome after surgery. We therefore investigated whether the age of the patient affects the subjective complaints or the objective severity of the nerve entrapment prior to surgery in patients younger than 40 years compared with those above 70 years of age.

DESIGN

Prospective study.

SETTING

NHS specialist neurophysiology department.

PARTICIPANTS

One hundred and six splint-resistant patients scored their subjective complaints and scores were then compared with the neurophysiology results.

MAIN OUTCOME MEASURES

Nerve conduction speeds and subjective visual analogue score of pain, sensation and motor function.

RESULTS

Conduction speeds were significantly more affected in patients over 70 years of age than in those under 40 years. Older patients scored their subjective complaints lower than younger patients.

CONCLUSIONS

Older patients' subjective complaints misrepresent the severity of the nerve entrapment. Clinicians should have a lower threshold for objective investigation of patients older than 70 years of age to minimize development of irreversible nerve damage.