To the Editor: Dr Gerritsen and colleagues1 found that surgery is more effective than nonsurgical
treatment for symptomatic CTS. However, they did not clearly distinguish CTS
from the separate entity of median nerve compression or median neuropathy
at the wrist (MNW). Surgery may be beneficial for patients with symptomatic
CTS even without evidence of MNW by nerve conduction studies.2 Conversely,
patients with MNW from concordant illnesses (eg, diabetes mellitus) can demonstrate
significant nerve conduction study abnormalities, yet may remain asymptomatic.3 Magnetic resonance neurographic data suggest that
surgery expands the cross-sectional area of the carpal tunnel allowing for
reduced pressure on the median nerve and adjacent structures, thereby producing
symptomatic benefit.4 In theory, median
nerve decompression should also be beneficial for patients with asymptomatic
MNW, but with significant nerve conduction study abnormalities. These authors
may have the data to address this issue.
Menkes DL. Splinting vs Surgery for Carpal Tunnel SyndromeSplinting vs Surgery for Carpal Tunnel Syndrome. JAMA. 2003;289(4):420–423. doi:10.1001/jama.289.4.420-a
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