Frequency of Radiculopathy in Patients with Carpal Tunnel Syndrome and Paracervical Pain (P5.106)

OBJECTIVE: To determine if patients with carpal tunnel syndrome (CTS) and neck or suprascapular pain (paracervical pain) have frequent electrophysiologic evidence of cervical radiculopathy. BACKGROUND: Patients with paracervical pain and paresthesias affecting a median distribution (or the entire hand) are often incorrectly diagnosed with cervical radiculopathy. Nerve conduction studies, in such patients, usually confirm median nerve entrapment. How frequent such patients have electrophysiologic evidence of cervical radiculopathy is unclear. DESIGN/METHODS: We reviewed charts from patients with CTS seen in our EMG laboratory between 2009 and 2011. All patients presented with clinical features of CTS and had at least one median nerve conduction parameter showing slowing across the wrist. Cases were divided into two groups: those with and without paracervical pain. Cervical radiculopathy was defined electrophysiologically as the presence of fibrillations in 2 or more muscles from the same myotome. The Fisher exact test was used to compare the frequency of radiculopathy between the groups and to determine if the rate of radiculopathy varied depending on the degree of median nerve entrapment (5 grades). A p value of <0.05 was considered statistically significant. RESULTS: Of 133 charts reviewed, 108 patients were included; there were 87 (80.56%) females and 21 (19.44%) males. Of 115 limbs meeting selection criteria, 59 (51.30%) had paracervical pain 56 (48.70%) did not. Ten of 59 limbs with paracervical pain (16.95%) and 6 of the 56 without pain (10.71%) had cervical radiculopathy (p=0.42). There was also no difference in the frequency of radiculopathy related to the severity of median nerve entrapment (p=0.57). CONCLUSIONS: In patients with median nerve distribution paresthesias, paracervical pain is not associated with more frequent cervical radiculopathy than those without paracervical pain. Cervical radiculopathy is not more frequent in patients with more severe CTS. Paracervical pain in patients with CTS is likely due to myofascial pain from spondylosis rather than radiculopathy. This may reflect an association of tenosynovitis with CTS rather than “double-crush’’ injury. Disclosure: Dr. Garcia Santibanez has nothing to disclose. Dr. Altememi has nothing to disclose. Dr. Scelsa has received royalty payments for Peripheral Neuropathies in Clinical Practice. Dr. Scelsa has received research support from the National Institutes of Health.