Acroparesthesia and carpal tunnel syndrome: a historical perspective

This article presents the history of acroparesthesia and its contribution to the discovery of idiopathic carpal tunnel syndrome (CTS). We used primary sources from the middle of the nineteenth century onward to show that the first short descriptions of patients with nocturnal and early morning paresthesias, numbness, pain, and weakness in the hands, without accompanying physical signs, were published around 1850. The condition was named acroparesthesia in 1890 and, in the following years, was accepted as a disease in medical textbooks. Almost all of the patients with acroparesthesia, described at the end of the nineteenth and the first half of the twentieth century, would today be diagnosed with idiopathic CTS. Although physicians proposed many hypotheses for the etiology of acroparesthesia throughout its 100-year history, they did not understand that the condition arose from compression of the median nerve in the carpal tunnel, and the concept of acroparesthesia did not lead to the discovery of CTS. Even Russell Brain-who, in 1946 and 1947, showed that the "syndrome of partial thenar atrophy" was due to compression of the median nerve in the carpal tunnel-did not realize that acroparesthesia shared the same origin. This understanding developed in the late 1940s and through the 1950s, and the disease came to be accepted under the name carpal tunnel syndrome.