Carpal tunnel syndrome

Somaiah Aroori, Roy A J Spence, Somaiah Aroori, Roy A J Spence

Abstract

Carpal tunnel syndrome is one of the most common peripheral neuropathies. It affects mainly middle aged women. In the majority of patients the exact cause and pathogenesis of CTS is unclear. Although several occupations have been linked to increased incidence and prevalence of CTS the evidence is not clear. Occupational CTS is uncommon and it is essential to exclude all other causes particularly the intrinsic factors such as obesity before attributing it to occupation. The risk of CTS is high in occupations involving exposure to high pressure, high force, repetitive work, and vibrating tools. The classic symptoms of CTS include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand. There are several physical examination tests that will help in the diagnosis of CTS but none of these tests are diagnostic on their own. The gold standard test is nerve conduction studies. However, they are also associated with false positive and false negative results. The diagnosis of CTS should be based on history, physical examination and results of electrophysiological studies. The patient with mild symptoms of CTS can be managed with conservative treatment, particularly local injection of steroids. However, in moderate to severe cases, surgery is the only treatment that provides cure. The basic principle of surgery is to increase the volume of the carpal tunnel by dividing transverse carpal ligament to release the pressure on the median nerve. Apart from early recovery and return to work there is no significant difference in terms of early and late complications and long-term pain relief between endoscopic and open carpal tunnel surgery.

Figures

Fig 1
Fig 1
Cross section across wrist (Reproduced, with permission from Bartleby.com: Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918.)
Fig 2
Fig 2
Picture showing moderate thenar atrophy of the left hand in a woman with bilateral carpal tunnel syndrome (Reproduced, with permission from George S. Phalen. The Carpal-Tunnel Syndrome: Seventeen Years' Experience In Diagnosis And Treatment Of Six Hundred Fifty-Four Hands. J Bone Joint Surg Am 1966; 48:211)
Fig 3
Fig 3
Picture showing moderate thenar atrophy of the right hand in a man with bilateral carpal tunnel syndrome

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