Prospects for a good outcome in the treatment of carpal tunnel syndrome diminish if intervention begins late, when the condition is far along.

Therefore, a key to success in dealing with this most common of entrapment neuropathies is to catch it in its earliest stages. This is especially the case for adults over the age of 50, suggest findings from the Albert Einstein College of Medicine’s Montefiore Medical Center in New York.

The research also suggests that “greater attention needs to be paid to objective evidence of carpal tunnel syndrome severity rather than subjective complaints when evaluating elderly adults...,” the investigators wrote in the journal.

Muscle & Nerve.

Other noteworthy observations by these same researchers:

Symptoms of carpel tunnel syndrome in older patients can be ambiguous; the condition appears to progress more rapidly in the elderly population; and electrophysiologic abnormalities seem to be both more common and severe in the older subjects.

In consequence to these findings, it is advisable for primary care physicians and other specialists to establish a low threshold for suspecting carpal tunnel syndrome. This is important for older adults who present complaints that their wrist, hand, palm or finger tingles, aches, feels numb or swollen. All of these symptoms can result in less gripping strength.

Risk factors

By way of reminder, carpal tunnel syndrome occurs following entrapment of the median nerve within the carpal tunnel, resulting in demyelination and then axonal degeneration.

Several theories exist to explain the cause of the syndrome, although likeliest is the existence of pressure within the carpal tunnel sufficient to obstruct venous outflow and produce back pressure, edema formation and nerve ischemia.

Risk factors include genetics, medical history, social status, vocations and avocations involving repetitive motions and demographics (whites are probably at highest risk; the female-to-male ratio is at least 3:1).

In the Montefiore study, researchers noticed that the incidence of carpal tunnel syndrome appears to peak in adults between the ages of 50 and 54, decreases after that and then climbs again to a second peak occurring between the ages of 75 and 84.

More thenar muscle wasting.

One of the objectives of the Montefiore study was to bolster the relatively thin understanding of the clinical and electrophysiologic characteristics of carpal tunnel syndrome in elderly adults.

“We examined age differences in clinical, functional and electrophysiologic features in elderly adults referred to a neuromusclar service for evaluation of symptoms suggestive of carpal tunnel syndrome,” the researchers wrote in the journal’s July 2006 issue. “Of 415 consecutive subjects referred over an 18 month period, 343 met clinical criteria for carpal tunnel syndrome. There were 158 young (less than 50 years), 115 middle-aged (51-64 years) and 70 elderly adults (over 65 years). Our findings are consistent with previous studies that found worsening electrophysiologic changes with increasing age.”

Carpal tunnel syndrome in older adults is reported to be associated with more thenar muscle wasting, particularly diurnal paresthesias, and more severe motor and sensory axon loss and indeed, in the Montefiore study, elderly adults demonstrated a higher prevalence of thenar weakness and thenar atrophy than younger subjects.

“There were also more patients with absent sensory potentials in the older group,” the team wrote.

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