The History of Carpal Tunnel Syndrome

Data from the Ohio Bureau of Workers' Compensation indicates that, as of 1989, carpal tunnel syndrome accounted for 49.1 percent of all claims for CTDs of the hands and wrists ( Praemer A. Furner S. , and Rice D. P. . 1992. Musculoskeletal Conditions in the United States. Park Ridge, Illinois: American Academy of Orthopaedic Surgeons, p. 103). The U.S. Bureau of Labor Statistics recently reported that “carpal tunnel syndrome is the most common disorder among repetitive motion cases” representing 36 percent of all disabling repetitive motion cases reported in 1992 (The BLS News, USDL-94-213, April 26, 1994). The average rate of occurrence of occupational carpal tunnel syndrome is estimated to be about 1.74 cases per 1,000 workers ( Franklin G.M. Haug J. Heyer N. Checkoway H. , and Peck N. . 1991. “Occupational Carpal Tunnel Syndrome in Washington State, 1984–1988.” American Journal of Public Health 81(6): 741–6). But in the automotive and electronics industries, the rate is 25 cases per 1,000 workers. See Madeja P. C. 1991. “Cumulative Trauma Disorders” Business Insurance (March 11):19.; and Pfeffer G.B. , and Gelberman R. H. . 1987. “The Carpal Tunnel Syndrome.” In Hadler N.M. , (ed.) Clinical Concepts in Regional Musculoskeletal Illness. Orlando: Grune & Stratton, pp. 201–15; and Schenck R. R. 1987. “Current Treatment of Carpal Tunnel Syndrome: Survey Results.” Presented at the 17th Annual Meeting of the American Association for Hand Surgery, San Juan, Puerto Rico, Nov. 4–8.

“Carpal Tunnel Syndrome May Be the ‘In’ Injury, But It Bears Attention.” The Chicago Tribune, October 4, 1989, p. 28; “Carpal Tunnel Syndrome Is a Big Workplace Issue.” The Chicago Tribune, September 27, 1992, Section C , p. 1. Examples of use as a generic descriptor include “Carpal Tunnel Lawsuits Are Consolidated,” The Wall Street Journal, June 3, 1992, p. B8; “Hands On Approach to Avoiding Carpal Tunnel Syndrome,” Risk Management, May, 1989, pp. 20–21; “Getting a Grasp on Carpal Tunnel Syndrome,” Risk Management, March, 1990, pp. 40–41. Millar J.D. 1991. Presentation at the conference “A National Strategy for Occupational Musculoskeletal Injury Prevention — Implementation Issues and Research Needs.” Sponsored by NIOSH and the University of Michigan's Center for Occupational Health and Safety Engineering, Ann Arbor, Michigan, (May, 1991).

Mosely L.H. Kalafut R.M. Levinson P.L. , and Mokris S.A. . 1991. “Management of Carpal Tunnel Syndrome.” In Kasdan M.L. , (ed.) Occupational Hand & Upper Extremity Injuries and Diseases. Philadelphia: Hanley & Belfus, Inc., p. 375; Onimus E. 1876. “On Professional Muscular Atrophy.” Lancet, (January 22):127–8; Putnam J.J. 1880. “A Series of Paræsthesia, Mainly of the Hands, of Periodical Recurrence, and Possibly of Vaso-Motor Origin.” Archives of Medicine 4: 150. It is interesting to note that the treatment provided by Dr. Putnam to this patient was cannabis. He states that it was too early to assess the effectiveness of that therapeutic approach.

Hirt L. 1893. The Diseases of the Nervous System. New York: D. Appleton & Co; Hunt J.R. 1911. “The Thenar and Hypothenar Types of Neural Atrophy of the Hand.” American Journal of the Medical Sciences 141: 224–41; Brouwer B. 1920. “The Significance of Phylogenetic and Ontogenetic Studies for the Neuropathologist.” The Journal of Nervous and Mental Disease 51(2): 113–36.

Bell C. 1830. The Nervous System of the Human Body. London; Solly S. 1864. “Scriveners' Palsy, or the Paralysis of Writers (Lecture I).” Lancet, (Dec. 24):709–ll; Poore G.V. 1897. Nervous Affections of the Hand. London: Smith, Elder, & Co.

Paget J. 1854. “Surgical Pathology.” In Turner W. , (ed.) Lectures on Surgical Pathology, Philadelphia, p. 42; Marie P. , and Foix C. . 1913. “Atrophie Isole de L'éminence Thénar D'origine Nevritique; Rôle du Ligament Annulaire Antérieur du Carpe Dans la Pathogénie de la Lésion.” Rev. Neurol. 26: 647–9; Learmouth J.R. 1933. “The Principles of Decompression in the Treatment of Certain Diseases of the Peripheral Nerves.” Surg. Clin. North America 13: 905–13; Moersch F.P. 1938. “Median Thenar Neuritis.” Proceedings of Staff Meetings Mayo Clinic 13 (April 6):220–2; Cannon B.W. , and Love J. G. . 1946. “Tardy Median Palsy Median Neuritis; Median Thenar Neuritis Amenable to Surgery.” Surgery 20: 210–6.

Phalen G.S. 1951. “Spontaneous Compression of the Median Nerve at the Wrist.” Journal of the American Medical Association 145: 1128–32; Phalen G.S. and Kendrick J. I. . 1957. “Compression Neuropathy of the Median Nerve in the Carpal Tunnel.” Journal of the American Medical Association 5: 524–30; Phalen G.S. 1966. “The Carpal Tunnel Syndrome: Seventeen Years' Experience in Diagnosis and Treatment of Six Hundred Fifty-Four Hands.” The Journal of Bone and Joint Surgery 48-A(2)211–28; Phalen G.S. 1972. “The Carpal Tunnel Syndrome.” Clinical Orthopaedics 83: 29–40.

Phalen 1951, p. 1130–1131; Phalen and Kendrick 1957, pp. 528–29; Phalen 1966, p. 219; Phalen 1972, pp. 33–34.

Phalen 1951, p. 1133.

Phalen 1966, p. 218.

Biographical information on George Phalen is based on archival material supplied by The Cleveland Clinic Foundation, along with telephone interviews conducted with Dr. Phalen on September 29, 1993 and July 18, 1994. Additional information was obtained through conversations with Mrs. Marie Kennedy, a close personal friend of Phalen and his wife. I wish to express my gratitude to Mr. Frederick Lautzenheiser, associate archivist of the Cleveland Clinic, for his assistance.

Interviews with Phalen: September 29, 1993 and July 18, 1994.

Tanzer R.L. 1959. “The Carpal Tunnel Syndrome; A Clinical and Anatomical Study.” Journal of Bone and Joint Surgery 41A: 626–34.

Tanzer 1959, p. 634.

Love J.G. 1955. “Median Neuritis; Carpal Tunnel Syndrome; Diagnosis and Treatment.” North Carolina Medical Journal 16: 463–69; Brain W.R. Wright A. D. , and Wilkinson M. . 1947. “Spontaneous Compression of Both Median Nerves in Carpal Tunnel: Six Cases Treated Surgically.” Lancet 1 (March 8):277–82.

See Phalen 1951, p. 1132.

Phalen himself suggested this view, for instance, in his 1966 article where he stated, “The fact that the majority of patients with carpal-tunnel syndrome are women at or near the menopause suggests that the soft tissues about the wrist may be affected in some manner by hormonal changes.” (p. 217).