Carpal tunnel syndrome with shoulder symptoms; is it a different entity? A prospective cohort study comparing recovery patterns following decompression

Abstract

IntroductionCarpal tunnel syndrome (CTS) may present with atypical proximal symptoms other than hand symptoms. Among proximal symptoms, shoulder symptoms are most distant to the site of compression and leads to a battery of investigations to exclude other pathologies. The recovery patterns of proximal symptoms have not been studied following carpal tunnel decompression.MethodA prospective cohort study was conducted to compare the recovery patterns between subgroup-A; CTS patients (n=55) with shoulder symptoms, with subgroup-B; patients (n=55) without shoulder symptoms. A pre-tested questionnaire was administered prior and after the surgery and information was gathered on day-7, day-14, and day-21.ResultsOf 110 patients, 81.8% were females. The mean age(±SD) of the total population was 49.2(±10.6), that of subgroup-A was 48.7(±10.3), and subgroup-B was 49.7(±11) years. They were predominantly right-handed (82.7%), 73% had their dominant hand affected while 74.5% were affected bilaterally at presentation. All had hand symptoms: numbness in 94.5%, pain in 85.4%, tingling of hand in 66.3% and all-three symptoms in 57.2%. In subgroup-A, pain was the predominant shoulder symptom which appeared before hand symptoms in 34.5%, after in 47.3% and simultaneously in 18.2%. It was aching-type in 91%. The pain radiated proximally (neck and scapula) in 61.8% and to the arm in 81.8%.The recovery rates (RR) of hand symptoms following decompression on day-7 were 41.8% in subgroup-A and 40.0% in subgroup-B. RR of hand symptoms in subgroup-A and subgroup-B on day-14 were 72.7% and 70.9%, while on day-21 were 83.6% and 85.5% respectively. RR of shoulder symptoms in subgroup-A were 38.2% on day-7, 65.4% on day-14, and 78.2% on day-21.ConclusionNear identical RR of hand and shoulder symptoms were seen between the two subgroups after decompression, which indicates CTS with shoulder symptoms is not a different entity.