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June 1, 1957


Author Affiliations


From the Department of Orthopedic Surgery, the Cleveland Clinic Foundation, and the Frank E. Bunts Educational Institute.

JAMA. 1957;164(5):524-530. doi:10.1001/jama.1957.02980050014005

• The median nerve as it leaves the forearm passes through the carpal tunnel in order to reach the hand. Within the tunnel it is subject to compression by neighboring structures because of space limitations imposed by the transverse carpal ligament. The resulting symptoms have been studied in 71 patients; they were bilateral in 39 and unilateral in 32. The right hand was affected in 23 and the left hand in only 9 of the unilateral cases. Seventeen patients were men. Diagnosis depended on sensory findings (pain and paresthesias) limited to the distribution of the median nerve in the hand, on prompt exacerbation of symptoms when the wrist was held in the flexed position, and on the production of tingling in the fingers by percussion over the carpal tunnel. Atrophy of thenar muscles was present in half the cases. Etiological and pathological findings favored the conception of this disorder as some type of localized rheumatic disease. Immobilization of the wrist by a splint and administration of hydrocortisone relieved the symptoms in many cases. Surgery, the simple sectioning of the transverse carpal ligament, was carried out on 49 wrists in 37 patients and generally sufficed to decompress the nerve and relieve symptoms. In three instances, however, a partial synovectomy had to be done in order to obtain adequate decompression.