Gradual onset diseases (eg, carpal tunnel syndrome, cubital tunnel syndrome, and trapeziometacarpal arthrosis) tend to go unnoticed for years. When a slowly progressive disease transitions from asymptomatic to symptomatic (unnoticed to noticed), it may seem like a new disease or even an injury. The primary aim of this study was to determine the percentage of patients who perceive a slowly progressive disease as having started within one year. It was found that a total of 69% of all subjects and 68% of people with advanced disease perceived the disease as having started within 1 year (1). A perceived provocation (such as an injury or surgery) was associated with a perception of recent onset. This is an indication of how commonly specialists will need to reorient understanding of a problem. Since asking people to rethink things can be off-putting, effective communication strategies are important to ensure that people are comfortable with the change. We want to help people make choices consistent with their values and not based on misconceptions.

New symptoms after an event at work are often interpreted as an injury and covered under worker’s compensation insurance. When the new symptoms are evaluated with MRI, radiologists often interpret observed signal changes as a tear, which could reinforce misconceptions about the symptoms. Using a convenience sample of occupational injury claimants with a bilateral MRI to evaluate new unilateral knee or shoulder symptoms ascribed to a single event at work, it was found that less than half of the patients with shoulder or knee symptoms had worse pathologic features on the symptomatic side, which reminds us of the importance of distinguishing age-related changes from acute injury (2).

A review of a hand surgeon’s practice identified that 23 of 58 patients with a new diagnosis of cubital tunnel syndrome had atrophy compared with only 62 of 370 patients with a new diagnosis of carpal tunnel syndrome (3). Age and diagnosis were factors significantly associated with atrophy at presentation. What this means is that patients with carpal tunnel syndrome tend to present earlier in the course of their disease than patients with cubital tunnel syndrome. It’s common for people with cubital tunnel syndrome not to seek attention until the problem is very advanced (muscle atrophy). This advanced nerve damage may not respond to surgery.

References

1. van Hoorn BT, Wilkens SC, Ring D. Gradual Onset Diseases: Misperception of Disease Onset. J Hand Surg Am. 2017 Sep 9. pii: S0363-5023(17)31272-8. doi:10.1016/j.jhsa.2017.07.021. [Epub ahead of print] PubMed PMID: 28899587.
2. Liu TC, Leung N, Edwards L, Ring D, Bernacki E, Tonn MD. Patients Older Than 40 Years With Unilateral Occupational Claims for New Shoulder and Knee Symptoms Have Bilateral MRI Changes. Clin Orthop Relat Res. 2017 Jun 9. doi:10.1007/s11999-017-5401-y. [Epub ahead of print] PubMed PMID: 28600690.
3. Mallette P, Zhao M, Zurakowski D, Ring D. Muscle Atrophy at Diagnosis of Carpal and Cubital Tunnel Syndrome. J Hand Surg [Am]. 2007;32(6):855-858.