Carpal tunnel release in patients with negative neurophysiological examinations: clinical and surgical findings.
OBJECTIVE
In 16% to 34% of patients with classic symptoms of carpal tunnel syndrome (CTS), neurophysiology is negative. Few studies have concentrated on patients with symptoms compatible with CTS with normal examinations. The purpose of our study was to examine the clinical and surgical characteristics of this subtype of CTS in order to clarify a correct approach toward these patients.


METHODS
We studied a subpopulation of 25 patients (31 hands) with typical CTS symptoms despite normal neurophysiological examinations. All of the patients were initially treated with conservative therapy, and patients with work-related symptoms were advised to change their duties. In patients with persistent symptoms, wrist ultrasound and radiographic and blood examinations with rheumatic screenings were performed. Cervical magnetic resonance imaging was performed in some cases to exclude cervical radiculopathy. Other pathologies were found in 5 cases. Nine patients improved with nonsurgical therapy. Six months later, electric examinations were repeated and 3 patients with a confirmed median nerve injury underwent surgery. Eight patients with negative examinations underwent surgery (10 hands). All patients were advised of the possibility of incomplete pain remission after surgery.


RESULTS
All patients improved after surgery. Median nerve injury was confirmed by operative findings according to Tuncali grading.


CONCLUSIONS
A combination of clinical findings and instrumental procedures is required when selecting patients for successful surgery.
Lama
Massimo
M
Department of Neurosurgery, Santa Maria di Loreto Hospital, Naples, Italy. carobene@unina.it
D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004185:Disability Evaluation; D018450:Disease Progression; D004568:Electrodiagnosis / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D014463:Ultrasonography; D014953:Wrist / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*