title: Pain and carpal tunnel syndrome.
abstract: OBJECTIVE
  Pain is not a classical symptom of carpal tunnel syndrome (CTS), with the exception of numbness that is so intense that it is described by patients as painful. The primary aim of our study was to determine which factors correlated with pain for patients diagnosed with CTS.
  
  
  METHODS
  We prospectively assessed all patients diagnosed with CTS in our unit over a 1-year period. We recorded demographic details for all patients, including past medical history, body mass index, smoking, and occupation. The diagnosis and severity of carpal tunnel syndrome were established through a combination of history, clinical assessment, and nerve conduction studies. Of 275 patients diagnosed and treated for CTS, 183 were women (67%), the mean age was 55 years (range, 22-87 y), and 166 cases were bilateral (60%). The mean body mass index was 29.5 kg/m2 (range, 17-48 kg/m2), and 81 patients smoked (30%). Patients completed a Short Form-McGill pain questionnaire (SF-MPQ) as a measure of pain at initial presentation. We assessed outcome 1 year after intervention using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score.
  
  
  RESULTS
  We found no association between pain according to the SF-MPQ and the positive clinical signs of CTS or positive nerve conduction studies. Multivariate analysis demonstrated that smoking and bilateral disease independently correlated with the overall SF-MPQ, with similar findings on subanalysis. Independent factors associated with an increased improvement in the QuickDASH at 1 year were the presentation QuickDASH score, positive nerve conduction studies, and smoking.
  
  
  CONCLUSIONS
  The only independent factors that correlated with pain at presentation of CTS were smoking and bilateral disease. Pain according to the SF-MPQ was not associated with classical clinical findings of the disease or with positive findings on nerve conduction testing.
  
  
  METHODS
  Prognostic I.
authors.affiliation: Department of Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, Fife, UK. andrew.duckworth@yahoo.co.uk
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Duckworth
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Jenkins
authors.forename: Philip
authors.initials: P
authors.lastname: Roddam
authors.forename: Adam C
authors.initials: AC
authors.lastname: Watts
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.forename: Jane E
authors.initials: JE
authors.lastname: McEachan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002349:Carpal Tunnel Syndrome / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods; D004185:Disability Evaluation; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009431:Neural Conduction / Q000502:physiology; D016273:Occupational Exposure / Q000009:adverse effects; D010146:Pain / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Carpal tunnel syndrome; diagnosis; nerve conduction studies; outcome; pain