Effect of age on subjective complaints and objective severity of carpal tunnel syndrome: prospective study

OBJECTIVES: Older patients with carpal tunnel syndrome who are resistant to conservative treatment often have a less than satisfactory outcome after surgery. We therefore investigated whether the age of the patient affects the subjective complaints or the objective severity of the nerve entrapment prior to surgery in patients younger than 40 years compared with those above 70 years of age. DESIGN: Prospective study. SETTING: NHS specialist neurophysiology department. PARTICIPANTS: One hundred and six splint-resistant patients scored their subjective complaints and scores were then compared with the neurophysiology results. MAIN OUTCOME MEASURES: Nerve conduction speeds and subjective visual analogue score of pain, sensation and motor function. RESULTS: Conduction speeds were significantly more affected in patients over 70 years of age than in those under 40 years. Older patients scored their subjective complaints lower than younger patients. CONCLUSIONS: Older patients' subjective complaints misrepresent the severity of the nerve entrapment. Clinicians should have a lower threshold for objective investigation of patients older than 70 years of age to minimize development of irreversible nerve damage.