gms | German Medical Science

Objectives/Interrogation: The natural history of carpal tunnel syndrome (course of untreated disease) is not well recognised. Older studies suggested that CTS progressed in time leading to median nerve compromise and subsequent loss of sensation, muscle weakness and functional impairment. However, more recent literature shows that a proportion of patients who were scheduled for surgery, cancelled it due to significant clinical improvement or permanent spontaneous recovery.

Methods: This work reports the results of an analysis into the course of carpal tunnel syndrome before operation in 479 patients, predominantly women, aged a mean of 58 years, who were scheduled for carpal tunnel operation. The patients were asked to characterise in detail the course of the disease and what determined the decision to undergo surgery.

Results and Conclusions: We identified two specific patterns of CTS course: progressive and preservative/mild. Patients with short-lasting disease suffer first of all from symptoms, but the longer the duration, the more pronounced the functional impairment. In a proportion of patients with longer-lasting disease, spontaneous resolution may occur, for up to a year or more. Bilateral involvement is more common than unilateral and the interval between involvement of the other hand is a mean of 10 months. For most patients the primary motivation to undergo surgery is troublesome symptoms (pain and paraesthesia). Functional impairment is of secondary importance, however, its prominence increases in older patients and in those with longer-lasting disease.