Intended for healthcare professionals

Rapid response to:

Clinical Review

Carpal tunnel syndrome

BMJ 2014; 349 doi: (Published 06 November 2014) Cite this as: BMJ 2014;349:g6437

Rapid Response:

Middleton and Anakwe state (1) that “Clinical examination of the cervical spine is usually enough to establish whether there is any important degenerative change at a relevant spinal level, in patients who do not have any neck symptoms or signs.”, and they continue “Patients with degenerative changes in the cervical spine may report pain, altered sensation, or motor signs in an atypical distribution for carpal tunnel syndrome and localised neck pain and stiffness, or both, as well as variation in their symptoms depending on cervical position or movement.”

This is actively misleading.

Degenerative change in the neck is not a cause of pain or altered sensation in the upper limb unless, (most commonly), nerve root irritation results from it.

Clinical examination is not enough to establish the degree and distribution of degenerative change but can help to establish (or exclude) nerve root irritation of the C6 or C7 nerve roots, on the symptomatic side, as a cause of carpal tunnel-like symptoms.

1. Middleton S, Anakwe R. Carpal Tunnel Syndrome. BMJ 2014;349: G6437 (8 November)

Competing interests: No competing interests

13 November 2014
Nicholas A Watson
Musculoskeletal physician
Nottingham, UK