Raynaud's Phenomenon in Idiopathic Carpal Tunnel Syndrome

Abstract

Both carpal tunnel syndrome and Raynaud's phenomonon are common conditions in the general population. These two different conditions frequently cause similar symptoms such as tingling, numbness, and "deadness of the fingers". They may also co-exist for instance in scleroderma or rheumatoid arthritis. In order to study the association, if any, between these two conditions, we studied 93 patients with idiopathic carpal tunnel syndrome confirmed in electro-physiological tests with 57 control subjects, for the presence of Raynaud's phenomenon by means of a previously validated questionnaire. Raynaud's phenomenon was detected significantly more frequently (P = 0.002) in patients with idiopathic carpal tunnel syndrome (36%) compared to control subjects (12%). Thus there appears to be an association between these two conditions. The mechanism for this is not clear. Sympathetic dysfunction may play a part. Practitioners should be aware of the similarity of the symptoms and the possibility that the two conditions may co-exist.

Autonomic dysfunction in idiopathic carpal tunnel syndrome

“…Nail changes and fingertip ulceration have been described in CTS but appear to be relatively uncommon or unreported in this and other series. 6,11,13,20 Pal et al 13 reported RP in 36% of their patients with CTS compared to 12% of normal controls. RP was seen only in 18% of our overall group and in 33% of the symptomatic autonomic cases, thus underscoring the point that an estimate of RP alone will underestimate the prevalence of autonomic disturbances in CTS.…”

“…From our literature review, 6,11,13,14,20 we identified a pool of eight items that assess autonomic symptoms in CTS. We reviewed the items with a local group of experts in neuromuscular diseases to obtain a final list of six items, assessed using a structured questionnaire.…”

“…We also excluded excessive sweating in the palms, as this symptom was not seen in our review as well as in our pilot study. 6,11,13,14,20 We rated the following symptoms in our subjects as "present" or "absent": RP, blanching of fingers, swelling of hands, dry palms, fingertip ulceration, and nail changes. The final questionnaire had an Cronbach's alpha coefficient of 0.9, which indicates excellent internal consistency for all the items on the questionnaire.…”

“…14 Previous reports have associated Raynaud's phenomenon (RP) and idiopathic carpal tunnel syndrome (CTS). 6,11,13,18 The practice parameters for CTS developed by the American Academy of Neurology include "dry skin, swelling or color changes in the hand" as some of the standard symptoms of CTS. 15 Although the sensorimotor manifestations of CTS are well known, the nature of any autonomic disturbances is not well documented.…”

Prevalence of Raynaud’s phenomenon in patients with idiopathic carpal tunnel syndrome

“…Linscheid, Peterson and Jeurgens 2 reported CTS associated with vasospasm, and Waller and Dathan 3 described cases of RP in which digital ischaemia appeared to have been exacerbated by CTS. Pal et al 4 reported the association in a more systematic study using groups of controls. The studies published so far are equivocal since the diagnosis of RP was not made on objective criteria.…”