To determine the role of personal variables as risk factors for carpal tunnel syndrome (CTS) and their relationship to severity of nerve conduction abnormality, we studied 210 consecutive symptomatic CTS patients and 320 controls subjects without CTS symptomatology or known systemic disorders. The CTS group was classified according to the severity of nerve conduction changes. The risk factors for CTS and its severity were assessed by means of univariate and multivariate analysis. Presence of CTS was significantly related to increase of body mass index (BMI) and wrist index. More severe nerve conduction abnormalities were associated with greater age and wrist index but not with higher BMI.

-According to median sensory latency ≥ 3.7 ms (wrist-index finger [WIF], 14 cm), median/ulnar sensory latency difference to ring finger ≥ 0.5 ms (14 cm) or median midpalm (8 cm) latency ≥ 2.3 ms (all peakmeasured), 141 Brazilian symptomatic patients (238 hands) have CTS confirmation. Wrist ratio (depth divided by width, WR) and a new wrist/palm ratio (wrist depth divided by the distance between distal wrist crease to the third digit metacarpophalangeal crease, WPR) were measured in all cases. Previous surgery/peripheral neuropathy were excluded; mean age 50.3 years; 90.8% female. Control subjects (486 hands) have mean age 43.0 years; 96.7% female. The mean WR in controls was 0.694 against 0.699, 0.703, 0.707 and 0.721 in CTS groups of progressive WIF severity. The mean WPR in controls was 0.374 against 0.376, 0.382, 0.387 and 0.403 in CTS groups of WIF progressive severity. Both were statistically significant for the last two groups (WIF > 4.4 ms, moderate, and, WIF unrecordable, severe). BMI increases togetherwith CTS severity and WR. It was concluded that both WR/WPR have a progressive correlation with the severity of CTS but with statistically significance only in groups moderate and severe. In these groups both WR and BMI have progressive increase and we believe that the latter could be a risk factor as important as important WR/WPR. KEY WORDS: carpal tunnel syndrome, median nerve, compressive neuropathy, wrist and palm ratio, wrist and hand dimension. Índices de palma/punho e síndrome do túnel do carpoRESUMO -Um grupo de 141 pacientes (238 mãos) com síndrome do túnel do carpo (STC) sintomático foi estudado após confirmação por condução nervosa: latência distal sensitiva do nervo mediano (LDS-M) ≥ 3,7 ms (punho -II dedo, 14 cm), diferença de latência sensitiva mediano-ulnar ≥ 0,5 ms (punho -IV dedo, 14 cm) e/ou latência palma-punho do nervo mediano ≥ 2,3 ms (8 cm); as latências foram medidas no pico do potencial. Todos os casos tiveram as seguintes medidas calculadas: 1. Índice do punho (IP, espessura dividido pela largura do punho); 2. Índice punho-palma (IPP, espessura do punho dividido pela distância entre a prega distal do punho e a prega mais proximal do III dedo); a média de idade foi de 50,3 anos com 90,8% do gênero feminino. PALAVRAS-CHAVE: síndrome do túnel do carpo, nervo mediano, neuropatia compressiva, dimensões do punho, condução nervosa.

-This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS) electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up). Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient) to 4 (severe) after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed) and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69%). Patient's satisfaction after surgical and non-surgical were respectively, 77.6% and 16% ("cure"), 13.6% and 52% (much improved), 5.4% and 9.3% (little improved), 2.7% and 16% (unchanged), 0.7% and 6.7% (worsed). The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value < 0.001) and was not influenced by the CTS electrophysiological severity. There was no relationship between the outcome after surgery and duration of symptomatology, age or CTS severity. Conservative benefice was more prevalent in those with shorter symptomatology and older age; the majority of conservative failure cases had mild initial CTS. We concluded the excellent surgical benefice described by patients and the absence of any predictive factors based on CTS severity, age or duration of symptomatology for outcome.KEY WORDS: carpal tunnel syndrome, median nerve, compression neuropathy, electrodiagnosis, nerve conduction.Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica RESUMO -O presente estudo tem por objetivo avaliar a terapia utilizada e o grau de satisfação dos pacientes que tiveram diagnóstico eletrofisiológico de síndrome do túnel do carpo (STC) entre 1989 e 1994 (528 casos); foram respondidas 184 cartas entre 528 enviadas (34,8%) sendo utilizadas 165. A gravidade do STC foi classificada de 0 a 4 de acordo com uma combinação de valores de latência distal sensitiva e amplitude do potencial de ação muscular composto do nervo mediano e diferença de latência sensitiva mediano/radial. As questões foram relativas a sintomatologia atual e terapêutica utilizada, cirúrgica ou conservadora. As respostas foram correlacionadas ao estudo de condução nervosa inicial, idade e tempo de sintomatologia. Os pacientes submetidos a cirurgia somaram 69% (114 casos). O benefício cirúrgico e não cirú...

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-This study was done to assess the percentage of abnormality in additional nerve conduction techniques after normal median distal latency (routine) in mild carpal tunnel syndrome (CTS). Bilateral nerve conduction studies were carried out in 116 consecutive symptomatic CTS patients (153 hands). Mild cases were based on normal routine (< 3.7 ms, peak-measured, 14 cm) and at least one technique abnormal of the following: sensory median-radial difference (MR); sensory median-ulnar difference (MU4); mixed palm medianulnar difference (MUP); median palm latency (PW); and motor median distal latency (MDL). After normal cutoff values for routine, 3.1 to 3.6 ms (< 3.7 ms), we found an abnormal MR, ranging from 86.6 to 93.4%, followed by MU4 (40 to 81.7%), MUP (20 to 71.2%), PW (0 to 41.1%), and MDL (0 to 19.6%). The most frequent abnormal association were MR plus MU4 in 90.1%, followed by MR plus MUP and MU4 plus MUP. The most frequent abnormal additional nerve conduction technique for mild CTS electrodiagnosis was MR, followed by MU4 and MUP. Percentage of MR abnormality was very high regardless of the median routine latency cut-off (< 3.1 to < 3.6 ms).KEY WORDS: carpal tunnel syndrome, median nerve, entrapment neuropathy, electrodiagnosis, nerve conduction. Utilidade de técnicas adicionais de condução nervosa para o dignóstico de síndrome do túnel do carpo leveRESUMO -Este estudo foi realizado para avaliação da percentagem de anormalidade de técnicas adicionais de condução nervosa no síndrome do túnel do carpo (STC) leve quando o valor de latência distal sensitiva do nervo mediano (rotina) está dentro dos limites normais. Condução nervosa bilateral foi realizada em 116 pacientes consecutivos com STC sintomático (153 mãos). A seleção foi feita baseada na rotina normal (< 3,7 ms, medida no pico, 14 cm) e, pelo menos uma técnica anormal entre as seguintes: diferença sensitiva medianoradial (MR); diferença sensitiva mediano-ulnar (MU4); diferença mediano-ulnar palmar (MUP); latência palmar do mediano (PW); e latência distal motora do mediano (MDL). Os valores normais da rotina foram separados em grupos desde 3,1 até 3,6 ms (< 3,7 ms), obtendo-se valores anormais entre 86,6 e 93,4% (MR), 40 e 81.7% (MU4), 20 e 71,2% (MUP), 0 e 41,1% (PW) e 0 e 19,6% (MDL). A associação anormal mais frequente foi MR com MU4 em 90,1%, seguido de MR com MUP e MU4 com MUP. A técnica adicional isolada anormal mais frequente foi MR seguida de MU4 e MUP. O percentual de anormalidade da técnica MR foi muito elevada, independentemente do valor de corte na condução rotina (3,1 a 3,6 ms). PALAVRAS-CHAVE: síndrome do túnel do carpo, nervo mediano, neuropatia compressiva, eletroneuromiografia, condução nervosa. Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in upper limbs. Electrodiagnosis is very sensitive and specific for the diagnosis and several studies have reported sensitivity in the range of 80 to 92% 1 . Comparison of the sensitivities of the various nerve conduction techniques for CTS diagnosis had demonstrated t...