I read with interest the article in the ARCHIVES "Concurrent Medical Disease in Work-Related Carpal Tunnel Syndrome"1 as well as its accompanying editorial, "The Many Faces of Carpal Tunnel Syndrome."2 This communication is intended to relay my experience in this matter and to comment on some suggestions made in these 2 communications.
Over approximately the last year I have seen 17 patients (16 men; 1 woman) with presumed work-related carpal tunnel syndrome (CTS). The average age of the men was 50.4 years at the time of the evaluation; of the woman,52 years. All had physical jobs that required repetitive use of the arms, hands, and wrists as well as the use of tools that would entail vibratory motions such as air hammers or jackhammers. I thoroughly evaluated each of these 17 patients using a patient history; physical examination; and testing that included serologic studies for connective tissue diseases such as antinuclear antibody and rheumatoid factor, erythrocyte sedimentation rate, thyroid function tests, which included one for thyrotropin, and others. None of the 17 patients I evaluated had hypothyroidism, diabetes mellitus, or arthropathies that, in my opinion, would cause nerve entrapment. Of course there were osteoarthritic changes in some joints that would be expected on the basis of the patient's age, but none had a severe osteoarthritic problem. None had rheumatoid arthritis, lupus erythematosus, or any other inflammatory connective tissue disease. None had gout, although approximately half of the patients were overweight. Therefore my experience differs from that of Atcheson et al.1 I believe it is important that all patients with CTS be evaluated as proposed by these, but conclusions based on the findings of slightly elevated thyrotropin or elevated fasting blood glucose levels need to be made with caution. In his editorial, Dr Yocum2 suggests that studies be conducted "eliminating those patients with medical disease typically associated with CTS, especially obesity." I would challenge Yocum to do such a study since many patients who do physically demanding jobs are obese, some also have glucose intolerance, and typically, there are those who are going to have some of the conditions described by Atcheson et al. I agree, however, with Yocum that "the diagnosis and treatment of these underlying illnesses typically lead to improvement."2 However, so does the removal of the stressors to the carpal tunnel such as repetitive muscular tasks involving the upper extremities whether it be in a work environment or with the patient doing recreational activities.