Serial nerve conduction studies in carpal tunnel syndrome secondary to rheumatoid arthritis: preliminary study

Twenty patients with definite rheumatoid arthritis fulfilling the criteria of the American Rheumatism Association were examined for clinical and electrodiagnostic evidence of carpal tunnel syndrome. Of the 40 wrists studied, 8 (20%) had evidence of carpal tunnel syndrome. All wrists were followed up with serial electrodiagnostic, clinical, and laboratory studies at intervals of 4 months over a period of a year. All patients were seen by a rheumatologist and were put on effective anti-inflammatory drug therapy. At each visit serum drug level and sedimentation rate were estimated. Two of the wrists were splinted. In the 4 affected patients (8 wrists) the drugs were used were aspirin in 3 and gold in 1. All 8 wrists showed a decrease in the abnormally prolonged median sensory latencies. This finding paralleled clinical improvement of rheumatoid disease as shown by symptomatic relief of paresthesia, reduced swelling of joints (including wrists), absence of Tinel sign at the median nerve, and fall of sedimentation rate. The study strongly suggests that serial electrodiagnostic studies should be used as 1 parameter in the follow-up of carpal tunnel syndrome secondary to rheumatoid arthritis. The study also indicates that good anti-inflammatory therapy and splinting can control carpal tunnel syndrome in rheumatoid arthritis. None of the wrists involved needed surgery during the period of study.