Subjective swelling - A new sign for carpal tunnel syndrome

This single-blinded, randomized cohort study of 186 patients was conducted to determine whether the subjective complaint of swelling of the hand or wr ist is associated with the diagnosis and/or prognosis of carpal funnel synd rome. All patients were referred for splinting with a presenting clinical d iagnosis of carpal tunnel syndrome from outpatient specialty clinics, inclu ding orthopedics, rheumatology, and neurology. Patients were assessed befor e splinting for the complaint of subjective swelling and underwent a clinic al examination including Phalen testing and carpal compression testing. In addition, 211 of the 290 joints underwent electrodiagnostic testing by the end of this study. Among the 211 joints for which electrodiagnosis was used , a chi(2) analysis was performed to determine the correlation among subjec tive swelling, the Phalen and carpal compression tests, and the electrodiag nostically verified carpal tunnel syndrome. Two weeks after splinting, an a ssessment was made of the subjective response to splinting. chi(2) analysis was then performed to assess the correlation among the Phalen test, carpal compression test, and nerve conduction study results and the symptom of su bjective swelling at presentation with that of response to splinting. Subje ctive swelling of the hand showed a trend toward association with electrodi agnostic results (although this finding was not statistically significant) and proved to be significantly correlated with a poor clinical response to splinting. Positive electrodiagnostic findings were significantly, though p ositively, correlated with pain relief from splinting. This study, therefor e, introduces the complaint of subjective swelling of the affected hand as an important diagnostic and prognostic symptom for the assessment and treat ment of carpal tunnel syndrome.