Response to letter from Dr M. D. O'Brien.

Abstract

Dear Sir, We are grateful to Dr O’Brien for highlighting the anatomy of the median nerve and its superficial palmar sensory branch. We agree that, based on anatomy alone, one would expect the palm to be unaffected in carpal tunnel syndrome (CTS), but the functional distinction between the palmar branch and the median nerve itself may not be as great as the anatomy suggests. Dr O’Brien highlights the anomaly of carpal tunnel decompression improving symptoms that would appear anatomically to be related to a more proximal lesion. We quoted work demonstrating glove distribution of symptoms in 35% of cases of CTS. Nora et al. [1] found that among patients with neurophysiological CTS, 44.4% had palmar pain and 62.2% had palmar paraesthesiae. Clark et al. found 39% prevalence of little finger symptoms in cases of CTS diagnosed by hand diagrams, neurophysiology and monofilaments [2]. A further confusion...