Carpal tunnel syndrome in the elderly

Carpal Tunnel Syndrome (CTS) involves a compression of the median nerve in the carpal tunnel. Incidence rates increase with age for men, whereas for women the rates peak at 45-54 years. Prevalence among older people is almost four times greater for women than for men. Fifty percent of cases are idiopathic and the rest associated with Colles' fracture, rheumatoid arthritis, hormonal agents and/or oophorectomy, diabetes mellitus, and among men, occupations with excessive use of hands. Age is a risk factor for slowing of sensory conduction of the median nerve. Examination includes provocative, sensibility and thenar muscle strength tests. Electrophysiologic studies confirm diagnosis. No evidence that NSAIDs, pyridoxine or diuretics work. Wrist splints, rest, local injections and oral steroids work better. Surgery is successful and even the very elderly show significant improvement. Although the level of satisfaction is lower than in younger adults, surgery is still worthwhile.