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CTS as a Herald of Connective Tissue Disorders

This study details the case histories of six patients aged 59-71 who presented to the author's clinic with symptoms of carpal tunnel syndrome (CTS). All six of these patients were later found to have some type of connective tissue disorder, usually some type of autoimmune rheumatic condition.

"Our cases illustrate that, like Raynaud's phenomenon [RP], CTS can herald inflammatory arthritis or a connective tissue disorder. This problem is compounded by the observation that many patients with RP present to their general practitioner complaining of pins-and-needles, numbness or throbbing in the digits and may not mention the triphasic colour changes that characterize RP. Furthermore, some patients with typical CTS without any associated cause may have features suggestive of RP as well, due to compression of sympathetic fibers in the median nerve. Indeed, many patients with CTS have an associated RP, and a general practitioner can easily miss this and fail to do the necessary investigations."

"In conclusion, we recommend a high index of suspicion in patients presenting with CTS...Follow-up is desirable, in case the condition is a herald of inflammatory or autoimmune disease."

Pal B. Carpal tunnel syndrome as a herald of autoimmune rheumatic disorders. Journal of the Royal Society of Medicine 1997;90:216-217.