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.