Compression Of Median Nerve In Carpal Tunnel And Its Relation To Acroparaesthesiae

Abstract

The clinical features of 53 cases of acroparaesthesiae are described ; dominant symptoms consisting of pain and paraesthesiae are almost invariably referred to the territory of the median nerve in the hand, and in the majority there is a slight objective deficit compatible with a median nerve lesion at the wrist. Electromyography and ischaemic sensory tests lend support for localization of the lesion at the wrist. The great predominance of female patients may be explained by the smaller size of the carpal tunnel in women and to occupational factors. In men the onset may be determined by osteoarthropathy of the wrist, trauma, or a change of employment. Division of the transverse carpal ligament gives immediate and lasting relief of symptoms and improvement of any neurological deficit that may have existed. In about one-third of the patients there is direct or indirect evidence of compression of the median nerve in the carpal tunnel at operation. Rest may alone relieve symptoms, but relapse occurs in the majority of patients when they resume a normal life. Some achieve no improvement and develop a progressive neurological deficit. © 1957, British Medical Journal Publishing Group. All rights reserved.