Abstract

 Background: Indian studies, especially from this part (NCR Region) are scarce in Carpal tunnel syndrome (CTS), the most common entrapment neuropathy. Aim of this study was to analyze clinical and electrophysiological profile in CTS.

Materials and Methods: 50 hands (35 patients) with clinical features compatible with CTS were included in the study. Detailed clinical, laboratory and electrophysiological evaluations of patients were done. The patients were followed up to a period of one year.

Results: The mean age of patients was 43.5 years with M: F ratio of 15: 38. Symptoms were bilateral in 30% of patients. The most common symptom was numbness sensation in hands, followed by pain while least common was colour change .Sensory loss was observed in 60% while clumsiness was noted in 40% of hands. Thyroid abnormalities were associated with 30% of hands. Mean EPS Grade was 3.32, with the most common electrophysiological abnormality was increase in latency difference between median and ulnar sensory nerves. This was also seen as the only electrophysiological abnormality in 8%. The least common abnormality was un-recordable CMAP. The patients with only a change in the sensory latency responded well to drugs and use of splint. Those who had in addition abnormal CMAP did not respond so well. The patients with thenar atrophy also did not respond well.

Conclusion: Carpal tunnel syndrome commonly presents with numbness in both hands with frequently associated hypothyroidism. Electrophysiological abnormalities can help in predicting the therapeutic response and prognosis. Abnormalities of CMAP and presence of atrophy are predictors of poor prognosis.

Keywords:  Carpal tunnel syndrome, Clinical, Nerve conduction study, Electrophysiological.

1.      Practice parameter for carpal tunnel syndrome [summary statement]. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1993;43:2406–2409.

2.      Murthy JMK, Meena AK : Carpal tunnel syndrome - Is it really uncommon in India? Neurol India 1995; 43 : 26-28.

3.      Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. 1988;38:134–138.

4.      Marshall S. Carpal tunnel syndrome. Clin Evid. 2001;5:717–728.

5.      Jackson D, Clifford JC : Electrodiagnosis of mild carpal tunnel syndrome. Arch Phys Med Rehabil 1989; 70 : 199-204.   

6.      Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77:6–17. 2. Cranford CS, Ho JY, Kalainov DM, Hartigan BJ. Carpal tunnel syndrome. J Am Acad Orthop Surg. 2007;15:537–48.

7.      Kotwal PP, Varshney MK. Carpal tunnel syndrome: Controversies and Consensus. Pb J Orthop. 2009;XI:32–7.

8.      Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V. The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health. 1994;84:1846–8.

9.      Cioni R, Passero S, Paradiso C et al : Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome. J Neurol 1989; 236 : 208-213.

10.  Prime MS, Palmer J, Khan WS, Goddard NJ. Is there light at the end of the tunnel?. Controversies in the diagnosis and management of carpal tunnel syndrome. Hand (N Y) 2010;5:354–60.

11.  Padua L, Pasqualetti P, Rosenbaum R. One patient, two carpal tunnels: Statistical and clinical analysis – by hand or by patient? Clin Neurophysiol. 2005;116:241–3.

12.  V Goyal et al :Electrophysiological Evaluation of 140 Hands with Carpal Tunnel Syndrome, J Assoc Physicians India 2001 : 49 : 1070-1073.

13.  Kasundra G M et al . Carpal tunnel syndrome: Analyzing efficacy and utility of clinical tests and various diagnostic modalities. J Neurosci Rural Pract. 2015 Oct-Dec; 6(4): 504–510.

14.  Simpson JA : Electrical signs in the diagnosis of carpal tunnel and related syndromes. J Neurol Neurosurg Psychiatry 1956; 19 : 275-280.

15.  Brown WF, Furguson GG, Joses MW et al : The location of conduction abnormalities in human entrapment neuropathies. Can J Neurol Sci 1976; 3 : 111-122.

16.  Murthy JMK :Carpal tunnel syndrome-electrodiagnostic aspects of fifty seven symptomatic hands: Neurol India 1999; 47 : 272-275.