Objective: To determine whether patients who present with tremor have an increased risk of carpal tunnel syndrome (CTS).

Background: Carpal tunnel syndrome is the most common mononeuropathy and can lead to significant functional impairment of the affected hand. Prior studies have suggested Parkinson’s disease with unilateral resting tremor is associated with increased risk of carpal tunnel syndrome in the unaffected arm; however, it is unclear whether patients with other forms of tremor are also at an increased risk of carpal tunnel syndrome [1].

Method: We included all patients who consecutively presented to movement disorders clinic at Mayo Clinic, Rochester during the months of September and October 2018. The tremor was classified as resting, action, or mixed. Patients were screened for signs and symptoms of carpal tunnel syndrome.

Results: Out of 36 patients that were consecutively seen, 16 had a complaint of tremor. Two patients had functional tremor, four patients had essential tremor, and ten patients had parkinsonism. Four patients had resting tremor, six had action tremor, and ten patients had mixed tremor. The median age was 62 (IQR 56.3-70.5) years, with the median duration of tremor onset to diagnosis of three (IQR 2.0-4.3) years.  Three (18.8%) of the sixteen patients had carpal tunnel syndrome. Of these, one patient had a mixed tremor, one had a resting tremor, and one had an action tremor. On EMG, two patients had findings of bilateral carpal tunnel syndrome with severe findings involving the more tremor-affected arm. None of the patients with essential tremor had carpal tunnel syndrome. None of the patients with CTS had any predisposing risk factors such as hypothyroidism, rheumatoid arthritis, diabetes mellitus, or obesity. Carpal tunnel syndrome tended to occur in patients with moderate to severe tremor versus mild tremor (p=0.0714).

Conclusion: Patients with moderate to severe tremor are more likely to develop symptoms of CTS in the tremor affected limb, though they may have electrophysiologic evidence of bilateral CTS. Essential tremor does not appear to have an increased risk of CTS. Larger cohort studies are needed to further confirm these findings.

References: [1] Han SW, Cheon KY, Kim JY, Baik JS. Carpal tunnel syndrome in patients with tremor dominant Parkinson’s disease. PLoS One. 2015 Jun 19;10(6):e0130779.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/carpal-tunnel-syndrome-in-patients-with-tremor/