Carpal tunnel syndrome historical perspective

Overview

Carpal tunnel syndrome (CTS) is the most common and a well–recognized mononeuropathy in medicine. Historical evaluations showed that it took more than 100 years from the initial reports and observations to describe the pathophysiology of this problem as a median nerve compression of wrist.

Historical Perspective

According to the available pieces of evidences about the Carpal tunnel syndrome (CTS) are interesting. The first description of median nerve illness in the carpal tunnel originates from 1854 and almost 100 years later this problem with its specific sign and symptoms called Carpal tunnel syndrome (CTS). Prior to this event, patients having these sign and symptoms were diagnosed as having acroparaesthesia or even the motor branch of the median nerve compression or the brachial plexus compression. Meanwhile, the "acroparesthesia" was used to describe a chronic and early morning and nocturnal paresthesias, numbness, pain, and weakness in hand with a slight decrease of sensibility of fingers; which was more common in female population. Nowadays, we can call this condition as Carpal tunnel syndrome (CTS). Here we can find the historical perspective of CTS in clinical practice:

In 1854, Paget J had the first clinical description of CTS in his two cases diagnosed with the median nerve compression within the carpal tunnel: one case was post-traumatic and another one was idiopathic

In 1880, Putnam JJ had reported the first case series of 37 patients which most of them were female with the age of 35 years old, suffering from the same problems: "the subjective sensibility impairment of the skin (which nowadays we call it as "numbness"), with repeatedly occurrence at nights or very early in the mornings and in some cases it’s been reported that shaking bit or hang out of the bed would decrease the symptoms. Which we can conclude that these previously mentioned symptoms nowadays are considered as symptoms of CTS.

In 1913, Marie and Foix published an article entitled “Atrophie isolée de l’éminence thenar d’origine névritique: rôle du ligament annulaire antérieur du carpe dans la pathogénie de la lésion”, which was an anatomopathological descriptions of the structural conversion affecting the median nerve due to the  carpal tunnel compression.

In 1914, Hunt JR, described the pathological evaluation of the thenar eminence atrophy. Which in his opinion it happened due to the motor branch compression of the median nerve within the carpal tunnel.

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The first reported description of carpal tunnel syndrome (CTS) was made by Paget in 1854, at the time he published a clinical and gross pathological description of CTS in his Lectures on Surgical Pathology [1,2]. In his report, he cited two patients in which he believed the median nerve was injured. In the first case, a man had a cord drawn tightly around his wrist, resulting in pain and impaired sensation in his hand, contraction of the fingers, and repeated ulcerations on the back of the hand. Seven years after the trauma, the arm was amputated because of intractable pain. A dissection of the amputated limb revealed ‘‘the median nerve, where it passes under the annular ligament, is enlarged with adhesions to all the adjacent tissues, and induration of both it and them’’ [3].