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Electrical studies in carpal tunnel syndrome.

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865
cyclophosphamide is highly suggestive that WG was the
cause of the nodules. Wegener’s granulomatosis should
be considered in the differential diagnosis of parotid
nodules.
JOEL KOVARSKY,
M.D.
Rheumatology Service
William Beaumont Army Medical Center
El Paso, Texas 79920
REFERENCES
1 . Liebow AA: Pulmonary angiitis and granulomatosis. Am
Rev Respir Dis 108:l-18, 1973
2. Fauci AS, WolfT SM: Wegener’s granulomatosis: studies in
eighteen patients and a review of the literature. Medicine
(Baltimore) 52535-561, 1973
3. Wolff SM, Fauci AS, Horn RG, Dale DC: Wegener’s granulomatosis. Ann Intern Med 81513-525, 1974
4. DeRemee RA, McDonald RJ, Harrison EG Jr, Coles DT:
Wegener’s granulomatosis: anarnotic correlates, a proposed classification. Mayo Clin Proc 51:777-781, 1976
5. Israel HL, Patchefsky AS, Saldana MJ: Wegener’s granulomatosis, lymphomatoid granulomatosis, and benign
lymphocytic angiitis and granulomatosis of the lung: recognition and treatment. Ann Intern Med 87:691-699, 1977
6. Fauci AS, Johnson RE, Wolff SM: Radiation therapy of
midline granuloma. Ann Intern Med 84:140-147, 1976
Carpal Tunnel Syndrome and Polymyalgia
Rheumatica in the Elderly
To the Editor:
I was interested to read the report of carpal tunnel syndrome with polymyalgia rheumatica by Ahmed
and Braun (Arthritis Rheum 21:221-223, 1978).
I n this part of the United Kingdom where over a
third of the population are aged 65 or more, carpal
tunnel syndrome and polymyalgia rheumatica are extremely common. In the past 2 years I have seen 12
elderly patients with this association. In 5 patients the
carpal tunnel syndrome appeared to precede the onset of
polymyalgia rheumatica by several weeks and was bilateral in 4 patients, being worse on the side of handedness.
In the other 7 patients the onset of polymyalgia and
carpal tunnel symptoms were more or less simultaneous
and associated in all 7 patients with marked shoulder
stiffness and swelling of the wrists and dorsum of the
hands. Again the symptoms were most marked on the
side of handedness. There was some relief of carpal
tunnel symptoms when treatment of the polymyalgia
was started with predisolone but all 12 patients at some
stage o r other required additional treatment by hydro-
cortisone injections and eventual surgical decompression was required in 3 patients.
N o unusual features were noted at operation and
I would suggest that the carpal tunnel symptoms arise
because of edema caused by the bilateral shoulder stiffness, though tenosynovitis might play a part. On the
other hand, this association could be purely fortuitous.
J. RICHARDS,
M.B., M.R.C.P.
ANTHONY
Department of Rheumatology
Worthing. Sussex
Worthing Sussex
England
Electrical Studies in Carpal
Tunnel Syndrome
To the Editor:
Ahmed and Braum present an interesting and
original article concerning the association of carpal tunnel syndrome with polymyalgia rheumatica (1). They
state that “. . . EMG and nerve conduction studies . . .
were not done because of clinical certainty of diagnosis”
(except for one case, but the results are not given).
The electrical findings in carpal tunnel syndrome
are usually so diagnostic that neglecting these electrical
studies in supposed cases of this syndrome (even with
clear clinical findings) should not be acceptable. It is not
infrequent in patients with symptoms of carpal tunnel
syndrome to find more widespread or less localized involvement which will be revealed by electrodiagnosis
(2).
True carpal tunnel syndrome frequently shows
only temporary relief from local steroid injection, with
surgery eventually required. To have 5 patients in a
series getting permanent relief from local or systemic
steroids is perhaps unusual. That these patients had
distal median nerve dysfunction appears likely from the
clinical description. It is unfortunate that this report was
not completed by median nerve motor and sensory
nerve latencies when the condition was first diagnosed
and after apparently successful treatment.
JOSEPH B. ROGOFF,M.D.
Director of Rehabilitation Medicine
Professor, New York Medical College
REFERENCES
1 . Ahmed T, Braun AI: Carpal tunnel syndrome with polymyalgia rheuma;:c:c. Art!iritis Rheum 21221-223, 1978
2. Peripheral Neuropathy. Fdlted by PJ Dyck, PK Thomas,
EH Lambert. Philadelphis, M . 3 . S:51.!r-dersCo., 1975, pp
696-697
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