Carpal tunnel syndrome with shoulder symptoms; is it a different entity? A prospective cohort study comparing recovery patterns following decompression

Background: Carpal tunnel syndrome (CTS) may present with atypical proximal symptoms other than hand symptoms.Among proximal symptoms, shoulder symptoms are most distant to the site of compression and leads to a battery of investigations to exclude other pathologies. The recovery patterns of proximal symptoms have not been studied following carpal tunnel decompression. Methods: A prospective cohort study was conducted to compare the recovery patterns between subgroup-A; CTS patients (n=55) with shoulder symptoms, with subgroup-B; patients (n=55) without shoulder symptoms. A pre-tested questionnaire was administered prior and after the surgery and information was gathered on day-7, day-14 and day-21. Results: Of 110 patients, 81.8% were females. The mean age(+SD) of the total population was 49.2(+10.6), that of subgroup-A was 48.7(+10.3), and subgroup-B was 49.7(+11) years. They were predominantly right-handed (82.7%), 73% had their dominant hand affected while 74.5% were affected bilaterally at presentation. All had hand symptoms: numbness in 94.5%, pain in 85.4%, tingling of hand in 66.3% and all-three symptoms in 57.2%. In subgroup-A, pain was the predominant shoulder symptom which appeared before hand symptoms in 34.5%, after in 47.3% and simultaneously in 18.2%. It was aching-type in 91%. The pain radiated proximally (neck and scapula) in 61.8% and to the arm in 81.8%. The recovery rates (RR) of hand symptoms following decompression on day-7 were 41.8% in subgroup-A and 40.0% in subgroup-B. RR of hand symptoms in subgroup-A and subgroup-B on day-14 were 72.7% and 70.9%, while on day-21 were 83.6%and 85.5% respectively. RR of shoulder symptoms in subgroup-A were 38.2% on day-7, 65.4% on day-14, and 78.2% on day-21. Conclusions: Near identical RR of hand and shoulder symptoms were seen between the two subgroups after decompression, which indicates CTS with shoulder symptoms is not a different entity.