James Paget’s median nerve compression (Putnam’s acroparaesthesia)

Sir James Paget (1814–1899) (fig 1) was a man of exceptional human and intellectual qualities.1 He is best known for his original accounts2 of On a form of chronic inflammation of the bones “osteitis deformans”,3 universally known as Paget’s disease of bone. He also first described Paget’s disease of the nipple, a sign of intraductal carcinoma in 1874,4 and as a student reported what is believed to be the first case of human trichinosis. Furthermore, and of interest to neurologists, the origins of the carpal tunnel syndrome may be found in Paget’s description of median nerve compression resulting from a radial fracture5 from St Bartholomew’s Hospital, London, in 1854: “Mr Hilton told me of this case: A man was at Guy’s Hospital, who, in consequence of a fracture of the lower end of the radius repaired by an excessive quantity of new bone, suffered compression of the median nerve. He had ulceration of the thumb and for and middle fingers, which resisted various treatment, and was cured only by so binding the wrist that, the parts on the palmar aspect being relaxed, the pressure on the nerve was removed. So long as this was done the ulcers became and remained well; but as soon as the man was allowed to use his hand, the pressure on the nerves was renewed, and the ulceration of the parts supplied by them returned.”

A little later, in Boston in 1880, James Jackson Putnam (1846–1918) (fig 1) gave an excellent portrayal of 37 patients with median compression at the wrist; subsequently the symptoms became known as Putnam’s acroparaesthesia: “A large number of cases … While differing from each other in minor respects, these cases agree …