Association Between Severity of Carpal Tunnel Syndrome and Pain in Wrist or Hand

Abstract

Introduction: Carpal tunnel syndrome (CTS) is the commonest and widely known entrapment neuropathy. Clinical symptoms, signs and nerve conduction studies have been used for diagnosis and severity assessment of CTS. Pain in hand or wrist is a commonly assessed symptom while different characters of pain are used for diagnosis and severity assessment. The aim of the current study was to identify characters of pain which are associated with the severity of CTS.

Methods: Five characters of pain which are commonly associated with CTS were assessed in 166 patients who were diagnosed to have CTS based on clinical and nerve conduction study findings. The severity of these characters was assessed using a five-grade scale. Correlation of severity of these characters with median motor nerve distal latency(MMDL)was estimated.

Results: Grading on 'how often did hand or wrist pain wake you up during a typical night' and 'severity of pain in hand or wrist during the daytime' correlated with MMDLwith Pearson correlations of 0.21 (p=0.008) and 0.19 (p=0.015), respectively. Scores of other three questions did not correlate with MMDL. Influence of age for this association was investigated by dividing the sample into two groups. Pain associated symptoms showed greater correlations with MMDL in patients aged 45-years or less than those above 45-years. Patients above 45-years presented with less severe symptoms but had more severe nerve compression determined by nerve conduction studies.

Conclusion: Only some characters of pain in hand or wrist correlated with the severity of median nerve compression. Age of the patients determined the degree of association witnessed in these subjects. Severe median nerve compression but less pain can be expected in elderly patients.