We studied 193 hands of 113 patients referred for typical carpal tunnel syndrome (CTS). Ninety-five (49%) hands had normal median distal motor latency (< or = 4.2 ms) and normal or borderline sensory conduction velocity from digit 2 stimulation (> or = 45 m/s). In these cases we performed three median to ulnar comparative tests: (1) difference between median and ulnar distal motor latencies recorded from the second lumbrical and interossei muscles (2L-INT); (2) difference between median and ulnar sensory latencies from digit 4 stimulation (D4M-D4U); and (3) difference between median and ulnar mixed nerve latencies from palmar stimulation (PM-PU). The 2L-INT difference was > or = 0.6 ms in 10% of hands. PM-PU and D4M-D4U were > or = 0.5 ms in 56% and 77% of hands, respectively. The greater sensitivity of D4M-D4U might be explained by the funicular topography and consequent greater susceptibility to compression of the cutaneous fibers from the third interspace which, at the distal carpal tunnel, are clumped superficially in the anteroulnar portion of the median nerve just beneath the transverse ligament.

We developed a hand brace and studied its efficacy and tolerability in patients with carpal tunnel syndrome (CTS). We randomized 83 subjects into a treated group, which wore the hand brace at night for 4 weeks, and a control group, which received no treatment. The primary efficacy measure was change in the Boston Carpal Tunnel Questionnaire (BCTQ) score. Secondary measures were Subjects' Global Impression of Change Questionnaire (SGICQ), median distal motor latency, sensory conduction velocity and amplitude, and neurophysiological class of severity. The treated group showed a reduction in BCTQ symptomatic score (from 2.75 to 1.54 at 4 weeks; P < 0.001) and functional score (from 1.89 to 1.48; P < 0.001). There were no significant changes in the control subjects. SGICQ documented improvement in all treated subjects (P = 0.006). No significant difference was found in electrophysiological measurements, but overall neurophysiological classification shifted to less severe classes in the treated group (P < 0.05). Thus, the study demonstrates that this hand brace is highly efficient in relieving symptoms and functional loss in CTS.

We studied the effect of the Manu(®) soft hand brace, which has been designed to relieve median nerve entrapment in carpal tunnel syndrome. An observational, controlled study was conducted in 10 participants, five with bilateral carpal tunnel syndrome and five controls, using sonography to study changes in the dimensions of the carpal tunnel before and while wearing the brace. An increase in transverse diameter, thinning of the flexor retinaculum, and displacement of the proximal insertion of the lumbrical muscle to the middle finger from the edge of the carpal tunnel were observed in patients while wearing the brace. The changes in the morphology of the carpal tunnel while wearing the Manu(®) support its use as an alternative to a night wrist splint.

We describe a maneuver that eases or abolishes paresthesias in carpal tunnel syndrome. With the affected hand palm up, the distal metacarpal heads are gently squeezed together; in some instances stretch of digits III and IV is also required. This maneuver may help in the clinical diagnosis of carpal tunnel syndrome, can be useful as a means of relieving symptoms, and provides the basis for the design of an innovative splint. Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy, with an incidence of 88-125 cases per 100,000 and a prevalence of 9.2% in women and 0.6% in men. 2,7 In the quest for a provocative test to aid in its diagnosis, we noticed that squeezing the distal heads of the metacarpal bones together had the opposite effect and actually relieved, when present, paresthesias and other positive symptoms of CTS. On the basis of this observation we developed a maneuver that we call the carpal tunnel syndrome relief maneuver (CTS-RM). In the basic maneuver, the affected hand is maintained with palm up and the distal heads of metacarpal bones (excluded the first) are gently squeezed inducing a slight adduction of digits II and V, so as to occlude the II and IV interdigital spaces (Fig. 1). When this is not sufficient to relieve symptoms, we turn the palm down and also stretch digits III and IV (Fig. 1). The aim of this study was to investigate the sensitivity, specificity, and efficacy of CTS-RM. MATERIALS AND METHODSWe examined 200 hands of 120 consecutive patients (101 women) referred to the EMG laboratory for hand paresthesias in the median nerve cutaneous distribution and pain exacerbation during the night. Mean age was 53.8 years (range 28-76 years). Duration of symptoms was 13.1 months (range 2 weeks to 7 years). At the time of clinical examination, 71 patients complained of positive symptoms such as paresthesias (tingling, "pins and needles," or a swollen sensation of the hands) or pain in a total of 112 hands.In these 112 hands we performed two maneuvers: (1) the basic relief maneuver combined, when symptoms were unaffected, with stretch of digits III and IV (Fig. 1); and (2) Phalen's test (extreme flexion of the wrist for 30 s). Patients were asked to indicate whether the maneuvers: (1) worsened; (2) did not change; (3) improved; or (4) abolished their symptoms. The patients were blinded to the possible effects of the maneuvers and the order of the maneuvers was random.At least 5 min after the maneuvers patients were studied electrophysiologically by determination of median sensory conduction velocity (SCV) from wrist to digit 2 (normal: Ն47 m/s) and median distal motor latency (DML) (normal: Յ4.2 ms). When these studies were normal, a median-to-ulnar comparison on stimulating the ring finger (normal median-ulnar latency difference: Յ0.5 ms) or a seg-

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