Carpal Tunnel Syndrome in the Very Elderly: Clinical, Electrodiagnostic, and Ultrasound Features in a Cohort of 187 Patients.

Background/objectives: Elderly patients with carpal tunnel syndrome (CTS) have more severe clinical, ultrasonic, and electrodiagnostic (EDX) findings compared to younger patients. Thenar weakness and atrophy are more common at initial presentation in the elderly population with CTS.

Methods: This is a retrospective review of 187 very elderly patients (aged 80 years and older) with EDX confirmation of CTS. We describe the clinical, EDX, and US features in these patients and compare the severity of the median nerve entrapment at the carpal tunnel (CT) by EDX findings to a middle-aged cohort (ages 40-50 years).

Results: The total number of very elderly hands with CTS was 289 (187 patients total, with bilateral symptoms in 102 patients). Of the 289 hands, thenar atrophy was observed in 75 (26.0%) hands, weakness of the abductor pollicis brevis (APB) muscle was detected in 178 (61.6%) hands, and pinprick decrease/loss was noted in 265 (91.7%) hands. Of the total 289 hands, 57 (66.3%) hands' median nerve stimulation did not evoke compound muscle action potentials over the APB and second lumbrical muscles. Sensory nerve action potentials were not detected in 211 (76.2%) hands. Comparing the sensitivities of various US measurements in diagnosing CTS, the cross-sectional area at the CT inlet had the highest sensitivity among the various measurements. As the CSA at the CT inlet increases, the odds of a greater CTS severity by EDX studies also increase (OR = 1.109, p-value = 0.001). The very elderly patients with CTS more frequently had more severe CTS compared to the middle-aged patients with CTS (chi-squared = 102.65₃, p-value < 0.001).

Conclusions: The very elderly patients appear to seek medical care only when the CTS has become severe. The primary care physicians should look for signs and symptoms of CTS in the very elderly and encourage prompt treatment. Surgeons should be cognizant of the differences in the clinical, EDX, and US studies in the very elderly patient cohort with CTS. US is highly useful in evaluating CTS when the EDX studies become non-localizing in severe CTS, as often seen in the very elderly patients.