Carpal tunnel syndrome in the presence of wrist flexion and absence of repetitive movements

One of the mechanical factors associated with carpal tunnel syndrome is repeated movement of flexion and extension at the wrist. The objective of this study was to determine whether prolonged positioning of flexion at the wrist, in the absence of repetitive movement, could cause carpal tunnel syndrome. The study was performed in a group of stroke patients with prolonged flexion but poor volitional movement at the wrist. Forty-right patients who suffered stroke at least 6 months before the study were included. Patients with severe spasticity (Ashworth scale > 3) and motor strength of > 2/5 were excluded. Tinels Phalen's, Semmes-Weinstein monofilament tests, median and ulnar nerve conduction studies were performed on all patients, if both nerves showed abnormal latencies or conduction, contralateral median and ulnar nerves and peroneal nerve in one extremity were also studied, to rule out peripheral neuropathy. Patients with peripheral neuropathy were subsequently excluded from the study. Carpal tunnel syndrome was diagnosed if distal motor latency was > 4.2 m sec and/or if distal sensory latency was > 3.5 m sec. Twenty-one patients met the inclusion criteria. None of them were wearing resting hand splint. Mean age of the patients was 61.2 +/- 9.9 yr. Resting position of the wrist was flexion in all patients. Seven of the 21 hands showed cat-pal tunnel syndrome (30%). There was no significant difference in the degree of wrist flexion between those who had and those who did not have carpal tunnel syndrome, demonstrating that carpal tunnel syndrome can occur in the presence of flexion of the wrist even in the absence of repetitive movements.