Electrophysiological evolution of patients with carpal tunnel syndrome untreated
Keywords:
carpal tunnel syndrome, natural history, electrodiagnosis.Abstract
Objective: to determine the electrophysiological evolution of the carpal tunnel syndrome (CTS) in untreated patients.Methods: between January and December 2009 were evaluated 189 patients with CTS who met the inclusion criteria and compared these results with previous studies to determine if from the electro- physiological standpoint, had improved, remained stable or had deteriorated.
Results: were evaluated 189 patients of whom only 114 (100 women and 14 men) met the inclusion criteria. Finally, 178 hands were the subject of the final study. The average among studies was 28.4 months (range 7-122). It was found that 16 (9%) patients improved, 109 (61.2%) remained stable and 53 (29.8%) worsened.
Conclusion: about two-thirds of untreated CTS patients remain stable from the electrophysiological point of view, while the remaining third worse.
References
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4. Armstrong T, Devor W, Borschel L, Contreras R. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve 2004 Jan;29(1):82-88.
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6. Bagatur AE. Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg (Brit) 2001;83B(5):655-658.
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8. Bendler EM, Greenspun B, Yu J, Erdman WJ 3rd. The bilaterality of carpal tunnel syndrome. Arch Phys Med Rehabil 1977; 58:362-364.
9. Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000;23(8):1280-1283.
10. Boyer MI. Corticosteroid injection for carpal tunnel syndrome. J Hand Surg Am 2008; 33(8):1414-1416.
11. Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements. Clin Neurol Neurosurg 2004;106(4):294-299.
12. Chan L, Turner JA, Comstock BA, LevensonLM, Hollingworth W, Heagerty PJ, Kliot M, Jar vik JG. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil 2007;88(1):19-24.
13. De Campos CC, Manzano GM, Leopoldino JF, Nóbrega JA, Sañudo A, de Araujo Peres C, Castelo A. The relationship between symptoms and electrophysiological detected compression of the median nerve at the wrist. Acta Neurol Scand 2004;110(6):398-402.
14. De Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in general population. J Clin Epidemiol 1992; 45(4): 373-376.
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17. Goloborod’ko SA. Provocative test for carpal tunnel syndrome. Journal of Hand Therapy 2004;17(3):344-348.
18. Hagebeuk EE, de Weerd AW. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004; 115(6):1464-1468.
19. Hamamoto Filho PT, Leite FV, Ruiz T, Resende LA. A systematic review of antiinflammatories for mild to moderate carpal tunnel syndrome. J Clin Neuromuscul Dis 2009;11(1):22-30.
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21. Lida J, Hirabayashi H, Nakase H, Sakaki T. Carpal tunnel syndrome: electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo) 2008Dec; 48(12):554-559.
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23. Kouyoumdjian JA, Morita MD, Rocha PR, Miranda RC, Gouveia GM. Body mass index and carpal tunnel syndrome. Arq Neuropsiquiatr 2000;58(2A):252-256.
24. Kouyoumdjian JA, Zanetta DM, Morita MP. Evaluation of age, body mass ndex, and wrist index as risk factors for carpal tunnel syndrome severity. Muscle Nerve 2002; 25(1):93-97.
25. Kuhlman KA. Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. American Journal of Physical Medicine & Rehabilitation 1997;76(6):451-457.
26. Kurt S, Kisacik B, Kaplan Y, Yildirim B, Etikan I, Karaer H. Obesity and carpal tunnel syndrome: is there a causal relationship? Eur Neurol 2008;59(5):253-257.
27. Lo JK, Finestone HM, Gilbert K. Prospective evaluation of the clinical prediction of electrodiagnostic results in carpal tunnel syndrome. PM R. 2009;1(7):612-619.
28. MacDermid JC. Kramer JF. McFarlane RM. Roth JH. Inter-rater agreement and accuracy of clinical tests used in diagnosis of Carpal Tunnel Syndrome. Work: A Journal of Prevention, Assessment & Rehabilitation 1997 Jan;8(1):37-44.
29. Moghtaderi A, Izadi S, Sharafadinzadeh N. An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome. Acta Neurol Scand 2005;112(6): 375-379.
30. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002;58(2):289-294.
31. Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 2004;107(1):64-69.
32. Nordstrom DL, DeStefano F, Vierkant RA, Layde PM. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 1998;9(3):342-345.
33. Ortiz-Corredor F, Enríquez F, Díaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clin Neurophysiol 2008;119(6):1373-1378.
34. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96(4):211-217.
35. Padua L, Lo Monaco M, Padua R, Gregori B, Tonali P. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 1997;18(3):145-150.
36. Padua L, Mondelli M; Italian CTS Study Group. Evolution of hand dysfunction and symptoms in untreated carpal tunnel syndrome. Muscle Nerve 2005Oct; 32(4): 545-547.
37. Padua L, Padua R, Lo Monaco M, Aprile I, Paciello N, Nazzaro M, Tonali P. Natural history of carpal tunnel syndrome according to the neurophysiological classification. Ital J Neurol Sci 1998;19(6):357-361.
38. Padua L, Padua R, Nazzaro M, Tonali P. Incidence of bilateral symptoms in carpal tunnel syndrome. J Hand Surg [Br] 1998; 23(5):603-606.
39. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology 2001;56:1459-1466.
40. Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am 2001; 26(3): 460-466.
41. Priganc VW, Henry SM. The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome. J Hand Ther 2003; 16(3):225- 236.
42. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg. M, Hales T, Katz JN, Pransky G. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998;88(10): 1447-1451. Review.
43. Resende LA, Tahara A, Fonseca RG, Sardenberg T. The natural history of carpal tunnel syndrome. A study of 20 hands evaluated 4 to 9 years after initial diagnosis. Electromyogr Clin Neurophysiol 2003Jul-Aug;43(5):301-304.
44. Robinson LR. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am 2007;18(4):733-746.
45. Roquelaure Y, Mariel J, Dano C, Fanello S, Penneau-Fontbonne D. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory. International Journal of Occupational Medicine and Environmental Health 2001;14:357-367.
46. Schrijver HM, Gerritsen AA, Strijers RL, Uitdehaag BM, Scholten RJ, de Vet HC, Bouter LM. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol 2005;22(3):216-221.
47. Stevens JC. The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997; 20:1477-1486.
48. Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988;38(1):134-138.
49. Stevens JC, Beard CM, O’Fallon WM, et al. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 1992; 67(6):541-548.
50. Tay LB, Urkude R, Verma KK. Clinical profile, electrodiagnosis and outcome in patients with carpal tunnel syndrome: a Singapore perspective. Singapore Med J 2006;7(12):1049-1052.
51. Treatment of Carpal Tunnel Syndrome: Evidence Report. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2008. Available at: http://www.aaos.org/research/ guidelines/CTSTreatmentEvidence Report2.pdf
52. Urbano FL. Tinel’s sign and Phalen’s maneuver: physical signs of carpal tunnel syndrome. Hospital Physician 2000 Jul; 36(7):39-40, 43-4.
53. Vennix MJ. Hirsh DD. Chiou-Tan FY. Rossi CD. Predicting acute denervation in carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation 1998;79(3):306-312.
54. Violante FS, Armstrong TJ, Fiorentini C, Graziosi F, Risi A, Venturi S, Curti S, Zanardi R, Cooke RMT, Bonfiglioli R, Mattioli S. Carpal tunnel syndrome and the manual work: a longitudinal study. Journal of Occupational and Environmental Medicine 2007;49(11):1189-1196.
55. You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve 1999; 22(4):497-501.
56. Werner RA, Franzblau A, Albers JW, Armstrong TJ. Influence of body mass index and work activity on the prevalence of median mononeuropathy at the wrist. Occup Environ Med 1997;54(4):268-271.
2. Asociación Antioqueña de Medicina Física y Rehabilitación. Consenso sobre criterios electrofisiológicos para el diagnóstico del STC.
3. Amo C, Fernández-Gil S, Pérez-Fernández S, Amo-Merino P, Amo-Usanos I, Franco C, González-Hidalgo M. Carpal tunnel syndrome: clinical and neuro physiological correlation: review of 100 cases. Rev Neurol 1998;27(157):490-493.
4. Armstrong T, Devor W, Borschel L, Contreras R. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve 2004 Jan;29(1):82-88.
5. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282(2):153-158.
6. Bagatur AE. Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg (Brit) 2001;83B(5):655-658.
7. Bena A, Mamo C, Argentero O, Baratti A, Bruno S, Ferraris F, Demaria M. Carpal tunnel syndrome (CTS) in the Piedmont Region: regional incidence and prevalence of CTS based on hospital records of patients who underwent surgery. Med Lav 2007;98(4):320-330.
8. Bendler EM, Greenspun B, Yu J, Erdman WJ 3rd. The bilaterality of carpal tunnel syndrome. Arch Phys Med Rehabil 1977; 58:362-364.
9. Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000;23(8):1280-1283.
10. Boyer MI. Corticosteroid injection for carpal tunnel syndrome. J Hand Surg Am 2008; 33(8):1414-1416.
11. Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements. Clin Neurol Neurosurg 2004;106(4):294-299.
12. Chan L, Turner JA, Comstock BA, LevensonLM, Hollingworth W, Heagerty PJ, Kliot M, Jar vik JG. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil 2007;88(1):19-24.
13. De Campos CC, Manzano GM, Leopoldino JF, Nóbrega JA, Sañudo A, de Araujo Peres C, Castelo A. The relationship between symptoms and electrophysiological detected compression of the median nerve at the wrist. Acta Neurol Scand 2004;110(6):398-402.
14. De Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in general population. J Clin Epidemiol 1992; 45(4): 373-376.
15. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg [Br] 2004; 29(4):315-320.
16. Giannini F, Cioni R, Mondelli M, Padua R, Gregori B, D’Amico P, Padua L. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinicalneurophysiological assessment. Clin Neurophysiol 2002;113(1):71-77.
17. Goloborod’ko SA. Provocative test for carpal tunnel syndrome. Journal of Hand Therapy 2004;17(3):344-348.
18. Hagebeuk EE, de Weerd AW. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004; 115(6):1464-1468.
19. Hamamoto Filho PT, Leite FV, Ruiz T, Resende LA. A systematic review of antiinflammatories for mild to moderate carpal tunnel syndrome. J Clin Neuromuscul Dis 2009;11(1):22-30.
20. Hoyos Arango B. Electrofisiología en el diagnóstico del síndrome del túnel del carpo. En: Fernández CF, Gutiérrez J y Quintero O (Editores). Medicina de Rehabilitación. Bogotá, D.C. Editora Guadalupe. 1.a ed. 2006;75-80.
21. Lida J, Hirabayashi H, Nakase H, Sakaki T. Carpal tunnel syndrome: electrophysiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir (Tokyo) 2008Dec; 48(12):554-559.
22. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A selfadministered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg (Am) 1993;75(11):1585-1592.
23. Kouyoumdjian JA, Morita MD, Rocha PR, Miranda RC, Gouveia GM. Body mass index and carpal tunnel syndrome. Arq Neuropsiquiatr 2000;58(2A):252-256.
24. Kouyoumdjian JA, Zanetta DM, Morita MP. Evaluation of age, body mass ndex, and wrist index as risk factors for carpal tunnel syndrome severity. Muscle Nerve 2002; 25(1):93-97.
25. Kuhlman KA. Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. American Journal of Physical Medicine & Rehabilitation 1997;76(6):451-457.
26. Kurt S, Kisacik B, Kaplan Y, Yildirim B, Etikan I, Karaer H. Obesity and carpal tunnel syndrome: is there a causal relationship? Eur Neurol 2008;59(5):253-257.
27. Lo JK, Finestone HM, Gilbert K. Prospective evaluation of the clinical prediction of electrodiagnostic results in carpal tunnel syndrome. PM R. 2009;1(7):612-619.
28. MacDermid JC. Kramer JF. McFarlane RM. Roth JH. Inter-rater agreement and accuracy of clinical tests used in diagnosis of Carpal Tunnel Syndrome. Work: A Journal of Prevention, Assessment & Rehabilitation 1997 Jan;8(1):37-44.
29. Moghtaderi A, Izadi S, Sharafadinzadeh N. An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome. Acta Neurol Scand 2005;112(6): 375-379.
30. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002;58(2):289-294.
31. Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg 2004;107(1):64-69.
32. Nordstrom DL, DeStefano F, Vierkant RA, Layde PM. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 1998;9(3):342-345.
33. Ortiz-Corredor F, Enríquez F, Díaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clin Neurophysiol 2008;119(6):1373-1378.
34. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96(4):211-217.
35. Padua L, Lo Monaco M, Padua R, Gregori B, Tonali P. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 1997;18(3):145-150.
36. Padua L, Mondelli M; Italian CTS Study Group. Evolution of hand dysfunction and symptoms in untreated carpal tunnel syndrome. Muscle Nerve 2005Oct; 32(4): 545-547.
37. Padua L, Padua R, Lo Monaco M, Aprile I, Paciello N, Nazzaro M, Tonali P. Natural history of carpal tunnel syndrome according to the neurophysiological classification. Ital J Neurol Sci 1998;19(6):357-361.
38. Padua L, Padua R, Nazzaro M, Tonali P. Incidence of bilateral symptoms in carpal tunnel syndrome. J Hand Surg [Br] 1998; 23(5):603-606.
39. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology 2001;56:1459-1466.
40. Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am 2001; 26(3): 460-466.
41. Priganc VW, Henry SM. The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome. J Hand Ther 2003; 16(3):225- 236.
42. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A, Gray R, Gerr F, Hagberg. M, Hales T, Katz JN, Pransky G. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998;88(10): 1447-1451. Review.
43. Resende LA, Tahara A, Fonseca RG, Sardenberg T. The natural history of carpal tunnel syndrome. A study of 20 hands evaluated 4 to 9 years after initial diagnosis. Electromyogr Clin Neurophysiol 2003Jul-Aug;43(5):301-304.
44. Robinson LR. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am 2007;18(4):733-746.
45. Roquelaure Y, Mariel J, Dano C, Fanello S, Penneau-Fontbonne D. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory. International Journal of Occupational Medicine and Environmental Health 2001;14:357-367.
46. Schrijver HM, Gerritsen AA, Strijers RL, Uitdehaag BM, Scholten RJ, de Vet HC, Bouter LM. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol 2005;22(3):216-221.
47. Stevens JC. The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997; 20:1477-1486.
48. Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988;38(1):134-138.
49. Stevens JC, Beard CM, O’Fallon WM, et al. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 1992; 67(6):541-548.
50. Tay LB, Urkude R, Verma KK. Clinical profile, electrodiagnosis and outcome in patients with carpal tunnel syndrome: a Singapore perspective. Singapore Med J 2006;7(12):1049-1052.
51. Treatment of Carpal Tunnel Syndrome: Evidence Report. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2008. Available at: http://www.aaos.org/research/ guidelines/CTSTreatmentEvidence Report2.pdf
52. Urbano FL. Tinel’s sign and Phalen’s maneuver: physical signs of carpal tunnel syndrome. Hospital Physician 2000 Jul; 36(7):39-40, 43-4.
53. Vennix MJ. Hirsh DD. Chiou-Tan FY. Rossi CD. Predicting acute denervation in carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation 1998;79(3):306-312.
54. Violante FS, Armstrong TJ, Fiorentini C, Graziosi F, Risi A, Venturi S, Curti S, Zanardi R, Cooke RMT, Bonfiglioli R, Mattioli S. Carpal tunnel syndrome and the manual work: a longitudinal study. Journal of Occupational and Environmental Medicine 2007;49(11):1189-1196.
55. You H, Simmons Z, Freivalds A, Kothari MJ, Naidu SH. Relationships between clinical symptom severity scales and nerve conduction measures in carpal tunnel syndrome. Muscle Nerve 1999; 22(4):497-501.
56. Werner RA, Franzblau A, Albers JW, Armstrong TJ. Influence of body mass index and work activity on the prevalence of median mononeuropathy at the wrist. Occup Environ Med 1997;54(4):268-271.
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1.
Hoyos Arango B. Electrophysiological evolution of patients with carpal tunnel syndrome untreated. Rev. Colomb. Med. Fis. Rehabil. [Internet]. 2012 Apr. 14 [cited 2024 May 17];21(1):32-40. Available from: https://revistacmfr.org/index.php/rcmfr/article/view/5
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