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To the Editor: Dr Gerritsen and colleagues¹ found that surgery is more effective than nonsurgical treatment for symptomatic CTS. However, they did not clearly distinguish CTS from the separate entity of median nerve compression or median neuropathy at the wrist (MNW). Surgery may be beneficial for patients with symptomatic CTS even without evidence of MNW by nerve conduction studies.² Conversely, patients with MNW from concordant illnesses (eg, diabetes mellitus) can demonstrate significant nerve conduction study abnormalities, yet may remain asymptomatic.³ Magnetic resonance neurographic data suggest that surgery expands the cross-sectional area of the carpal tunnel allowing for reduced pressure on the median nerve and adjacent structures, thereby producing symptomatic benefit.⁴ In theory, median nerve decompression should also be beneficial for patients with asymptomatic MNW, but with significant nerve conduction study abnormalities. These authors may have the data to address this issue.

Daniel L. Menkes, MD
Department of Neurology
University of . . . [Full Text of this Article]

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