History of CTS / Differential Diagnosis

1.  Brain, R.W., Wright, A.D., Wilkinson, M, “Spontaneous compression of both median nerves in the carpal tunnel: Six cases treated surgically.” Lancet, 1947; 1:277-282.

The classic. Introduces the concept of CTS due to median nerve entrapment at the carpal tunnel with relief of symptoms after cutting the transverse carpal ligament. It also introduces the concept of bilateral, spontaneous onset.

2.  Carroll, R.E. and Hurst, L.C. “The Relationship of Thoracic Outlet syndrome and Carpal tunnel syndrome.” CORR, 1982; 164:149-150.

3.  Levine, D.W., Simmons, B.P., Doris, M.J., “A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.” JBJS, 1993; 75A: 1585-92.

The title says it all. It is not practical, however.

4.  Pfeffer, G.B., Gelberman, R.G., Boyes, J.H. and Rydevik, B., “The history of carpal tunnel syndrome.” JHS, 1988; 13B: 28-34.

This was a nice review of history of carpal tunnel syndrome. It helps to point out how long the incorrect diagnosis of thoracic outlet syndrome was the basis for treatment of carpal tunnel syndrome. The review of the history of carpal tunnel syndrome reflects the difficulty in figuring out the pathophysiology of a medical problem and arriving at the proper diagnosis and treatment of the problem. This article gives a good foundation for anyone interested in understanding misconceptions that have interfered with proper diagnosis and treatment of CTS.

5.  Werner, C.O., Rosen, I., and Thorngren, K.G. “Clinical and neurophysiologic characteristics of the pronator syndrome.” CORR, 1985; 197:231-236.

One of Werner’s classic studies with intraoperative nerve monitoring while stimulating muscle contraction. Pronator muscle entrapment of the median nerve high in the forearm may mimic CTS.