Carpal tunnel syndrome

Few conditions in neurology seem as simple or straightforward as carpal tunnel syndrome (CTS). The symptoms caused by compression of the median nerve at the wrist are one of the most common reasons that patients are referred to neurologists, especially for electrodiagnostic study. In recognition of the 10% lifetime risk for development of CTS and its importance as a cause of disability, the Quality Standards Subcommittee of the American Academy of Neurology developed practice parameters for its diagnosis and management.1,2⇓ These guidelines address diagnosis more thoroughly than management. Management of a disabled worker remains a challenging problem from the individual and the public health perspective. CTS is among the four most frequent causes for permanent and temporary partial disability that are covered by workers’ compensation.3 The average case of occupational CTS has been estimated to cost $5,000 per limb affected.4 Three articles in this issue of Neurology address a range of issues that illustrate the complexity of this “simple” condition.5-7⇓⇓ The incidence of CTS has been increasing over the last two decades, with much public attention focused on computer keyboard usage. Although the National Institute for Occupational Safety and Health accepts that there is a positive association between …