Treating Carpal Tunnel Syndrome in the Elderly: Too little Too Late?

Carpal tunnel syndrome is the most common peripheral neuropathy presenting to specialist hand and wrist clinics. Surgical decompression of the carpal tunnel considered if non-surgical options have failed. Surgical outcomes may be impaired if damage to the peripheral nerve damage is extensive. Despite conflicting evidence, there is mounting evidence that surgical outcomes for carpal tunnel syndrome are worse in more elderly populations. Indeed, it was found that 50% of patients with bilateral carpal tunnel syndrome aged over 60 have completely absent sensory nerve conduction. More extensive nerve damage in older patient groups may be due to delayed presentation following reduced pain sensitivity with age, reductions in nerve conduction velocities with the normal aging process and reduced axonal regeneration capacity with aging. Whilst more research is required, these findings should influence consenting information given to patients considered for surgery.