Carpal tunnel syndrome as a manifestation of systemic disease.

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Abstract
Forty-one of 54 patients having undergone surgery for median nerve compression at the wrist were reviewed post-operatively after an average of 7 years 9 months. Of these 41 patients, 36 were female, their average age being 53 years. In the whole series the right hand was involved alone or more severely on 43 occasions and the left on 11. At the time of review 31 patients had no symptoms and only one had recurrent or persistent trouble of moderate severity. In 6 patients, local disorders at the wrist could be incriminated etiologically. The remaining 35 included 3 males who have been omitted from the statistical study. The incidence pre-operatively and on review of cervical spondylosis, generalized osteo-arthritis, and rheumatoid arthritis in these 32 women was compared with the known incidence of these diseases in random samples of the general population. Statistically no difference was noted. Trigger finger occurred in the ipsilateral limb in 17 per cent of these women, but the incidence of this disorder in the general population is not known. The predominant involvement of the dominant hand is of great significance. The carpal tunnel syndrome is mainly a disorder of post-menopausal females (often with an associated trigger finger) and occurs most frequently in the dominant hand. The influence of estrogen withdrawal, repetitive minimal trauma, and sexual variations in anatomy at the wrist are discussed.