Desk–edge syndrome: median nerve injury proximal to the carpal tunnel

Abstract Background: Twelve women working full time as keyboard operators had median nerve entrapment attributable to pressure on the median nerve proximal to the tunnel from resting their wrists on a hard surface in full‐time keyboard work. Methods: As all were examined concerning legal dispute on attributability to work, there was extensive documentation dating back 1–15 years. Eleven were recalled for re‐examination. Results: Eleven of 12 had reduced sensation of median nerve distribution, including the thenar area supplied by the superficial cutaneous branch which passes over the tunnel. The sensory distribution of the superficial nerve was still affected in 10 of 11 re‐examined. Nerve conduction tests were abnormal in five of six tested. Surgery had not been successful in the eight cases operated on. Eight improved on using soft‐gel wrist‐rests and two on ceasing keyboard work. Conclusion: Median nerve injury proximal to the carpal tunnel can simulate CTS but does not respond to carpal release surgery. Involvement of the superficial branch of the nerve distinguishes this syndrome from the conventional CTS. Similar cases should be managed and/or prevented by providing suitable wrist‐rests or typing with the wrists raised.