Phalen, J Bone Joint Surg Am 1950 - Neuropathy of the Median Nerve Due to Compression Beneath the Transverse Carpal Ligament

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Neuropathy of the Median Nerve Due to Compression Beneath the Transverse Carpal Ligament

Phalen, La Londe, et al.·J Bone Joint Surg Am·1950·175 citations·Case series

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Phalen, Gardner, and La Londe report three surgically treated cases of spontaneous median nerve compression beneath the transverse carpal ligament — no prior injury, no arthritis — and describe the clinical features, operative findings, and outcomes that define what we now call carpal tunnel syndrome.

Key Findings

Surgical division of the transverse carpal ligament achieved excellent symptom relief in all 3 operative cases, with pain and paresthesias resolving within days to weeks postoperatively
Two findings emerged as the most reliable diagnostic criteria for median nerve compression at the wrist:
- Positive Tinel's sign over the median nerve at the wrist
- Sensory changes strictly limited to the median distribution distal to the wrist
The authors state the condition is apparently always bilateral, with symptoms usually worse in the hand the patient uses more (all 10 cases, their 4 and Brain et al.'s 6, were women)
Differential diagnosis must exclude cervical disc herniation, syringomyelia, progressive muscular atrophy, and scalenus anterior syndrome before attributing symptoms to carpal tunnel compression
Section of the transverse carpal ligament produced no functional disability; minor flexor tendon bulging occurred with wrist flexion but was absent in the functional extended position

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Neuropathy of the Median Nerve Due to Compression Beneath the Transverse Carpal Ligament

Phalen, La Londe, et al.·J Bone Joint Surg Am·1950·175 citations·Case series

|

Phalen, Gardner, and La Londe report three surgically treated cases of spontaneous median nerve compression beneath the transverse carpal ligament — no prior injury, no arthritis — and describe the clinical features, operative findings, and outcomes that define what we now call carpal tunnel syndrome.

Key Findings

Surgical division of the transverse carpal ligament achieved excellent symptom relief in all 3 operative cases, with pain and paresthesias resolving within days to weeks postoperatively
Two findings emerged as the most reliable diagnostic criteria for median nerve compression at the wrist:
- Positive Tinel's sign over the median nerve at the wrist
- Sensory changes strictly limited to the median distribution distal to the wrist
The authors state the condition is apparently always bilateral, with symptoms usually worse in the hand the patient uses more (all 10 cases, their 4 and Brain et al.'s 6, were women)
Differential diagnosis must exclude cervical disc herniation, syringomyelia, progressive muscular atrophy, and scalenus anterior syndrome before attributing symptoms to carpal tunnel compression
Section of the transverse carpal ligament produced no functional disability; minor flexor tendon bulging occurred with wrist flexion but was absent in the functional extended position

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