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We evaluated the natural history of median nerve sensory conduction, hand/wrist symptoms, and carpal tunnel syndrome (CTS) in an 11-year longitudinal study of 289 workers from four industries. Twenty hands which had carpal tunnel release surgery were excluded, leaving 558 hands for the primary study group. Overall, the trend was for mean sensory latencies and prevalence of slowing to increase, the prevalence of symptoms to decrease, and the prevalence of CTS to remain unchanged. Among individual hands, nerve conduction abnormalities tended to persist (82% 11-year persistence), while symptoms fluctuated widely (13% 11-year persistence). There was a strong, direct linear correlation between initial severity of slowing and subsequent development of CTS; however, most workers who developed de novo slowing did not develop symptoms or CTS. We conclude that changes in conduction status of the median nerve occur naturally with increasing age and do not necessarily lead to symptoms and CTS. Carpal tunnel syndrome (CTS) is the clinical expression of the most frequently diagnosed entrapment neuropathy of the upper extremity. 5,15,18,19 Confirmation of the diagnosis of CTS involves objective validation of median nerve abnormality within the carpal tunnel. 5,6,20 The most reliable method with which to obtain this objective confirmation is electrodiagnostic studies. 5,20 Longitudinal studies are required to determine the natural history of any chronic disease or pathologic process, including median neuropathy; cohort studies provide the most reliable evidence for trends in individuals. 4 With regard to median nerve slowing and CTS, we know of only two such longitudinal studies, including our previously reported 5-year follow-up of this same sample of industrial workers. 3,12 As part of an ongoing study of the etiology of median nerve slowing and CTS in industry, we evaluated a group of 283 industrial workers three times over a period of 11 years. This longitudinal study provides objective information on long-term trends in CTS in this population. It has excluded 20 hands which had carpal tunnel release surgery (CTR) (16 during 11-year interval, 4 prior to inception of study). This article presents our findings with regard to nerve conduction studies, self-reported hand/ wrist symptoms, and an objectively confirmed case definition of CTS. We hypothesized that median nerve sensory latencies, symptoms, and CTS would increase over time and that the development of symptoms and CTS would correlate with the progression of the median nerve slowing.

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Anterior transposition and/or medial epicondylectomy are often considered procedures of choice for ulnar neuropathy at the elbow. Much experience suggests simple decompression to be a comparably effective alternative which involves less trauma, morbidity, and rehabilitation time. The post-operative clinical and electrophysiological results of 52 cases of simple decompression (41 patients) are summarized. Excellent or good clinical results were found in 75% of the nerves. Mean ulnar motor conduction velocities were significantly improved post-operatively, although nerve conduction parameters did not consistently correlate with clinical outcome. The average return-to-work time was 5.1 weeks. The advantages of simple decompression make it the procedure of choice for most cases of ulnar neuropathy.