Sensory distribution indicates severity of median nerve damage in carpal tunnel syndrome

• Published in: Clinical neurophysiology 2008-07, Vol.119 (7), p.1619-1625
• Main Authors: Wilder-Smith, E.P, Ng, E.S, Chan, Y.H, Therimadasamy, A.K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aging - physiology; Analysis of Variance; Asian Continental Ancestry Group; Biological and medical sciences; Body Mass Index; Carpal tunnel syndrome; Carpal Tunnel Syndrome - pathology; Clinical neurology; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Education; Electrodiagnosis; Electrodiagnosis. Electric activity recording; Electrophysiology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Median nerve; Median Nerve - pathology; Medical sciences; Middle Aged; Motor Neurons - physiology; Nerve conduction; Nervous system; Nervous system (semeiology, syndromes); Neural Conduction - physiology; Neurology; Neurons, Afferent - physiology; Prospective Studies; Sensation - physiology; Sensory distribution
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2008.03.022

Abstract Objective Sensory symptoms within the median nerve distribution are a primary clinical diagnostic criterion for the diagnosis of carpal tunnel syndrome (CTS). However, the distribution of the sensory symptoms in CTS varies from patient to patient. This study identifies the clinical and electrophysiological findings that correlate with the distribution of sensory symptoms in an Asian population with CTS. Methods In a prospective study of 105 patients with electrophysiologically confirmed CTS, clinical and educational data were correlated with sensory symptom distribution. Results Median nerve distribution was strongly associated with more severe nerve conduction abnormality, male gender, and relief by movement. Patients with a complete median sensory distribution had more electrophysiological abnormality than those with an incomplete median distribution. Extra-median distribution was associated with the least nerve conduction abnormality. Educational qualification, age, symptom duration and body mass index were not associated with the pattern of sensory symptoms. Conclusions In carpal tunnel syndrome, sensory symptom distribution is strongly dependant on the degree of electrophysiological median nerve damage. Median nerve sensory distribution is associated with severe nerve damage. Significance This study provides clinicians with a simple clinical rule for assigning the degree of median nerve damage in patients with CTS based on sensory distribution patterns.