Carpal tunnel syndrome in the elderly. "Beware of severe cases".

This study compares the clinical and electrophysiological features of Carpal Tunnel Syndrome (CTS) in elderly (over 70 years of age) and middle age populations (50-60 years of age). Our study shows a severe (95%) electrophysiological motor and sensory denervation of CTS, in 60% of the elderly group and only 18% of the middle aged group (P much much less than 10(-3). Clinically, the presence of thenar wasting was the only reliable sign of significant denervation, Phalen's test, Tinel sign and painful paresthesia being equivocal. Some 18% of the elderly were asymptomatic despite 25% of these patients having severe neurological impairment. It was noted that exclusively diurnal paresthesiae were confined to the elderly group (23%) (P much less than 10(-3)). To avoid permanent disability the elderly should be viewed as a high risk group of severe cases even in the absence of firm clinical evidence and should undergo objective electrophysiological assessment with a view to surgical intervention as a priority.