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To the Editor: Dr Atroshi and colleagues¹ reported on the population prevalence of carpal tunnel syndrome (CTS), but their methods and conclusions raise 3 questions.

First, this study addresses patients not hands. Surely there was not 100% concordance between symptoms, physical signs, and nerve conduction studies between the patient's hands. How did the authors analyze data for a patient with bilateral symptoms but unilateral physical findings or nerve conduction studies?

Second, physical findings are notoriously unreliable in the diagnosis of CTS, especially in less severe cases. "Clinically certain CTS" would be more accurately described as "clinically suspected CTS." Furthermore, CTS was defined as either symptoms plus signs, or symptoms plus positive nerve conduction studies. In light of the greater reliability and clinical accuracy of nerve conduction tests,² it would seem prudent to define CTS as symptoms plus positive nerve conduction studies, with or without physical signs.

Third, caution should be . . . [Full Text of this Article]

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Prevalence of Carpal Tunnel Syndrome in a General Population
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