NEUROPATHIC SYMPTOMS AND MUSCULOSKELETAL PAIN IN CARPAL-TUNNEL SYNDROME - PROGNOSTIC AND THERAPEUTIC IMPLICATIONS

BACKGROUND Repetitive activities in the workplace can not only jeopard ize the median nerve across the carpal tunnel but also the musculoskel etal structures, such as the ligaments, synovia, tendons and muscles p roducing pain, and local tenderness at the wrist, elbow, and shoulder. The occurrence of this latter condition can dominate the overall clin ical picture and affect the outcome of treatments for this very common condition, METHODS A clinical evaluation of 30 patients who previousl y underwent a successful and uncomplicated carpal tunnel release surge ry was conducted. These patients were referred back for another electr odiagnostic study to consider the possibility of persistent or recurre nt nerve entrapment. These patients all had musculoskeletal pain and l ocal tenderness at the wrist, elbow, and shoulder as their primary and disabling symptoms; and neuropathic symptoms as their less disabling complaints, RESULTS All patients reported significant resolution of th eir neuropathic symptoms following surgery but their musculoskeletal s ymptoms persisted preventing them from returning to their original occ upation, Fifty percent showed mild to moderate improvement in their el ectrophysiologic abnormalities but none had complete normalization of nerve conduction, Few patients developed symptoms of sympathetic nerve overactivity. CONCLUSIONS Some patients suffering from carpal tunnel syndrome may present with a disabling musculoskeletal pain and local t enderness in the upper extremities that can persist following surgery despite resolution of neuropathic symptoms, These two symptom complexe s, although both sequelae of repetitive activities, have fundamental c linicopathologic differences that must be recognized because of their therapeutic, prognostic, and medico-legal implications. (C) 1997 by El sevier Science Inc.