Clinician expectation and anatomical studies suggest that the distribution of sensory dysfunction in carpal tunnel syndrome (CTS) should be confined to the thumb, index, middle and half of the ring fingers. We mapped the distribution of disturbance to evaluate the accuracy of these assumptions.

We evaluated 64 wrists in 64 patients with nerve conduction study confirmed CTS. Each patient filled out a Katz hand diagram and we collated the distribution of pain and non-painful (tingling, numbness & decreased sensation) sensory disturbance. Frequency of reporting was analysed; dividing symptoms into thenar and hypo-thenar eminence, distal palm, each digit, posterior hand and forearm.

Non-painful sensory disturbance occurred in all patients. The index finger was the most common location (94%) followed by the middle finger (91%), the distal palm (84%), the ring finger (72%), the thumb (69%), the thenar eminence (63%), the little finger (39%), the dorsal hand (31%), the hypothenar eminence (25%) and the forearm (13%).

Pain was less common, reported in 59% of cases. Pain occurred most frequently over the wrist crease (33%) followed by thenar eminence (27%), the forearm (20%), the middle finger (23%), the index finger (22%), the ring finger (19%), the distal palm (16%), the thumb (14%), the dorsal hand (11%), the little finger (11%) and least frequently the hypothenar eminence (6%)

In CTS sensory disturbance occurs most frequently in the median nerve distribution; however it occurs almost as often elsewhere. An atypical distribution of symptoms should not discourage diagnosis of CTS.

Tibial shaft fracture occurs commonly in the young active population with high demands. Tibial fracture is potentially life changing. There are no published studies with long-term follow-up to provide accurate prognostic information regarding return to leisure activities, employment and driving.

We aim to define the patient demographic and mechanism of injury and quantify the time period following tibial shaft fracture to return to sport and sporting level achieved at long-term follow-up. A retrospective multi-centre study was performed. Data collection was by questionnaire including Tegner activity scale score for sporting level and closed questioning on employment and driving.

Ninety-three patients were recruited with an average 46 month (18–64mo) follow-up period. Patients were predominantly male (77%) with a median age at injury of 37 years. Road traffic accidents were responsible for 43% of injuries; sport 31%; falls 25% and assault 1%. High energy mechanisms accounted for 49% of injuries Seventy-eight percent of patients felt that prognostic information given at the time of injury was inaccurate.

At follow-up, only 31% had regained their original level of sporting ability. Median Tegner score prior to injury score was 5 and at 18 months the mean score fell by 1.85. Patients sustaining high energy injuries were worst affected, dropping an average of 2.13 compared to low energy mechanisms with an average fall of 1.35 on the Tegner scale (p=0.503). High demand patients had a greater reduction in functional outcome, with a fall of 0.8 for patients with pre-injury activity level of 1–3 compared to the fall of 2.6 on the scale for more active patients scoring 7–9 pre-injury.

Tibial fracture can result in significant long-term morbidity. Patients sustaining high energy injuries and high demand patients have significantly worse outcome. Patients are unlikely to achieve their pre-injury level of sporting activity at 2 years.