Carpal tunnel syndrome: a review of the recent literature

I Ibrahim, W S Khan, N Goddard, P Smitham, I Ibrahim, W S Khan, N Goddard, P Smitham

Abstract

Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging.

Keywords: Carpal tunnel syndrome; diagnosis.; entrapment neuropathy; median nerve; pathophysiology.

References

    1. Paget J. Lectures on surgic pathology. Philadelphia: Lindsay and Blakiston; 1854.
    1. Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis treatment and follow-up of the carpal tunnel syndrome: a review. Neurolog Sci. 2010;31(3):243–52.
    1. American Academy of Orthopaedic Surgeons Work Group Panel. Clinical guidelines on diagnosis of carpal tunnel syndrome. 2007.
    1. Amirlak B, Upadhyaya K, Ahmed O, Wolff T, Tsai T, Scheker L. [Accessed: 24/10/2011];Median Nerve Entrapment. 1-11-2010. Internet Communication. 2011
    1. Padua L, LoMonaco M, Padua R. Neurophysiological classification of carpal tunnel syndrome assessment of 600 symptomatic hands. Ital J Neurol Sci. 1997;18:145–50.
    1. INAIL: Italian Worker's Compensation Authority, Annual Report 2000. Available at: . [Accessed: 24/10/2011].
    1. Lo SL, Raskin K, Lester H, Lester B. Carpal tunnel syndrome a historical perspective. Hand Clin. 2002;18(2):211–7.
    1. Pfeffer GB, Gelberman RH, Boyes JH, Rydevik B. The history of carpal tunnel syndrome. J Hand Surg Br. 1988;13(1):28–34.
    1. Aroori S, Spence RA. Carpal tunnel syndro. [Review] [135 refs] Ulster Medical J. 2008;77(1):6–17.
    1. Burns TM. Mechanisms of acute and chronic compression neuropathy. In: Dyck PJ, Thomas PK, editors. Peripheral neuropathy. 4th. Amsterdam: Elsevier; 2005. pp. 1391–402.
    1. Danielsson LG. Iatrogenic pronator syndrome case report. Scand J Plast Reconstr Surg. 1980;14(2):201–3.
    1. Hartz CR, Linscheid RL, Gramse RR, Daube JR. he pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am. 1981;63(6):885–90.
    1. Rask MR. Anterior interosseous nerve entrapment: (Kiloh-Nevin syndrome) report of seven cases. Clin Orthop Relat Res. 1979;142:176–81.
    1. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8.
    1. Uchiyama S, Itsubo T, Nakamura K, Kat H, Yasutomi T, Momose T. Current concepts of carpal tunnel syndrome pathophysiology treatment, and evaluation. J Orthop Sci. 2010;15:1–13.
    1. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology. 2002;58:289–94.
    1. Phalen GS. The carpal-tunnel syndrome. J Bone and Joint Surg Am. 1966;48(A):380–3.
    1. European Agency for Safety and Health at Work. Work related neck and upper limb musculoskeletal disorders. Office for Official Publication of the European Communities, Luxembourg. 1999.
    1. Monograph containing 87 methods of analysis studies and experiences for prevention of musculoskeletal disorders of the upper limb biomechanical overload. J Occup Med. 1996
    1. Kim JY, Kim JI, Son JE, Yun SK. Prevalence of carpal tunnel syndrome in meat and fish processing plants. J Occup Health. 2004; 46(3):230–4.
    1. Gelfman R, Melton LJ, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology. 2009;72:33–41.
    1. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565–9.
    1. Finsen V, Zeitlmann H. Carpal tunnel syndrome during pregnancy. Scand J Plast Reconstr Surg Hand Surg. 2006;40(1):41–5.
    1. Prime MS, Palmer J, Khan WS, Goddard NJ. Is there Light at the End of the Tunnel? Controversies in the Diagnosis and Management of Carpal Tunnel Syndrome. Hand. 2010;5(4):354–60.
    1. Solomon L, Warwick D, Nayagam S. Apley's concise system of orthopaedics and fractures. NY: Oxford University Press; 2005.
    1. Zyluk A, Kosovets L. An assessment of the sympathetic function within the hand in patients with carpal tunnel syndrome. J Hand Surg Eur Vol. 2010;35(5):402–8.
    1. Dorwart BB. Carpal tunnel syndrome a review [Review] [63 refs] Seminars in Arthritis & Rheumatism. 1984;14(2):134–40.
    1. Krendel DA, Jobsis M, Gaskell PC, Jr, Sanders DB. The flick sign in carpal tunnel syndrome. J Neurol Neurosurg Psychiatr. 1986;49(2):220–1.
    1. Stevens JC, Smith BE, Weaver AL, Bosch EP, Deen HG, Wilkens JA. Symptoms of 100 patients with electromyographically verified carpal tunnel syndrome. Muscle Nerve. 1999;22(10):1448–56.
    1. Kumar P, Chakrabarti I. Idiopathic carpal tunnel syndrome and trigger finger: is there an association? J Hand Surg European Volume. 2009;34(1):58–9.
    1. Padua L, Padua R, Aprile I, D'amico P, Tonali P. Carpal tunnel syndrome: relationship between clinical and patient-orientated assessment. Clin Orthop. 2002;395:128–34.
    1. MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome a narrative review. J Orthop Sports Phys Ther. 2004;34(10):565–88.
    1. Burke DT, Burke MA, Bell R, Stewart GW, Mehdi RS, Kim HJ. Subjective swelling a new sign for carpal tunnel syndrome. Am J Phys Med Rehabil. 1999;78(6):504–8.
    1. Bland JD. The value of the history in the diagnosis ofcarpal tunnel syndrome. J Hand Surg Br. 2000;25:445–50.
    1. Nora DB, Becker J, Ehlers JA, Gomes I. Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome. Clin Neurol Neurosurg. 2004;107(1):64–9.
    1. Dorwart BB. Volar Hot Dog at the wrist: A new sign in carpal tunnel syndrome. Clin Res. 1983;31(694A) Abstract.
    1. Kummel BM, Zazanis GA. Shoulder pain as the presenting complaint in carpal tunnel syndrome. Clin Orthop. 1973;92:227–30.
    1. Sakellarides HT. The management of carpal tunnel compression syndrome. Follow-up of 500 cases over a 25 year period. Orthop Rev. 1983;12:77–81.
    1. Braun RM, Davidson K, Doehr S. Provocative testing in the diagnosis of dynamic carpal tunnel syndrome. J Hand Surgery [Am] 1989;14:195–7.
    1. Chell J, Stevens A, Davis TR. Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women. J Bone Joint Surg Am. 1999;81(5):868–70.
    1. Martin S. Carpal tunnel syndrome a job-related risk. Am Pharmacy. 1991;31(8):21–4.
    1. Nathan PA, Meadows KD, Doyle LS. Occupation as a risk factor for impaired sensory conduction of the median nerce at the carpal tunnel. J Hand Surg Br. 1988;13:167–70.
    1. Pelmear PL, Taylor W. Carpal tunnel syndrome and hand-arm vibration syndrome. A diagnostic enigma. [Review] [45 refs] Arch Neurol. 1994;51(4):416–20.
    1. Werner RA, Andary M. Carpal tunnel syndrome pathophysiology and clinical neurophysiology [Review] [71 refs] Clin Neurophysiol. 2002;113(9):1373–81.
    1. Gelberman RH, Rydevik BL, Pess GM, Szabo RM, Lundborg G. Carpal tunnel syndrome. A scientific basis for clinical care. Orthop Clin North Am. 1988;19(1):115–24.
    1. Werner CO, Elmqvist D, Ohlin P. Pressure and nerve lesion in the carpal tunnel. Acta Orthopaedica Scandinavica. 1983;54(2):312–6.
    1. Werner RA, Armstrong TJ. Carpal tunnel syndrome: ergonomic risk factors and intra carpal canal pressure carpal tunnel syndrome. Phys Med Rehabil Clin N Am. 1997;8(3):555–69.
    1. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002;18(2):231–41.
    1. Wehbe MA, Schlegel JM. Nerve gliding exercies for thoracic outlet syndrome. Hand Clin. 2004;20(1):51–5.
    1. Millesi H, Zoch G, Rath T. The gliding apparatus ofperipheral nerve and its clinical significance. Ann Chir Main Memb Super. 1990;9:87–97.
    1. LaBan MM, MacKenzie JR, Zemenick GA. Anatomic observations in carpal tunnel syndrome as they relate to the tethered median nerve stress test. Arch Phys Med Rehabil. 1989;70(1):44–6.
    1. Lundborg G, Gelberman RH, Minteer-Convery M. Median nerve compression in the carpal tunnel - Functional response to experimentally induced controlled pressure. J Hand Surg. 1982;7(3):252–9.
    1. Lundborg G. Intraneural microcirculation. Orthop Clin North Am. 1988;19(1):1–12.
    1. Sud V, Tucci MA, Freeland AE, Smith WT, Grinspun K. Absorptive properties of synovium harvested from the carpal tunnel. Microsurgery. 2002;22(7):316–9.
    1. Yoshii Y, Zhao C, Zhao KD, Zobitz ME, An KN, Amadio PC. The effect of wrist position on the relative motion of tendon nerve and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res. 2008;26(8):1153–8.
    1. Armstrong TJ, Castello W, Evans F, Diaz-Perez R. Some histological changes in carpal tunnel contents and their biomechanical implications. J Occup Med. 1984;26:197–201.
    1. Bay BK, Sharkey NA, Szabo RM. Displacement and strain of the median nerve at the wrist. J Hand Surg Am. 1997;22:621–7.
    1. Crevier-Denoix N, Collobert C, Sanaa M, Bernard N, Joly C, Pourcelot P. Mechanical correlations derived from segmental histologic study of the equine superficial digital flexor tendon, from foal to adult. Am J Vet Res. 1998;59:969–77.
    1. Yoon JH, Halper J. Tendon proteoglycans: biochemistry and function. J Musculoskeletal Neuronal Interact. 2005;5:22–4.
    1. Phalen GS. The carpal tunnel syndrome seventeen years experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg. 1966;48A:211–28.
    1. Hirata H, Nagakura T, Tsujii M. The relationshiot of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol. 2004; 205(5):606–12.
    1. Ettema AM, Amadio PC, Zhao C. A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. J Bone and Joint Surgery Am . 2004;86-A(7):1458–66.
    1. Lundborg G. Nerve entrapment. In: Lundborg G, editor. Nerve injury and repair. Philadelphia: Churchill Livingstone; 1988. pp. 102–48.
    1. Colombini D, Occhipinti E, Cairoli S. Le affezioni muscoloscheletriche degli arti superiori e inferiori come patologie professionali; quali e a quali condizioni. Documento di consenso di un gruppo di lavoro nazionale. Med Lav. 2003;94(3):312–29.
    1. Netter Neurologie. II. Germany: Thieme; 2007.
    1. Kuhlman KA. Sensitivity and specificity of carpal tunnel syndrome sign. Am J Phys Med Rehabil. 1997;76:451–7.
    1. Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo JC, Erausquin C. What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome? Clin Exp Rhemutatol. 2007;25:853–9.
    1. Amirfeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br. 2005;30:361–4.
    1. D'Arcy CA, McGee S. The rational clinical examination does this patient have carpal tunnel syndrome? JAMA. 2000;283(3110):3117–0.
    1. DeKrom MC, Knipschild PG, Kester AD. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome. Lancet. 1990;335:393–5.
    1. ElMiedany Y, Ashour S, Youssef S. Clinical diagnosis of carpal tunnel syndrome old tests-new concepts. Joint Bone Spine. 2008;75:451–7.
    1. Graham B. The value added by electro-diagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone and Joint Surgery Am . 2008;90(2587):2593.
    1. Mackinnon SE, Novak CB, Landau WM. Clinical diagnosisof carpal tunnel syndrome. JAMA. 2000;284:1924–5.
    1. Kamath V, Stothard J. A clinical questionnaire for thediagnosis of carpal tunnel syndrome. J Hand Surg Br. 2003;28:455–9.
    1. Levine DW, Simmons BP, Koris MJ. A self-administered questionnaire for the assessment of severityof symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am . 1993;75:1585–92.
    1. Ahn DS. Hand elevation a new test for carpal tunnel syndrome. Ann Plast Surg. 2001;46:120–4.
    1. Simpson JA. Electrical signs in the diagnosis of carpal tunnel and related syndromes. J Neurol Neurosurg Psychiatry. 1956;19(275):280.
    1. Swash M, Schwarts M. Nerve entrapment and compression syndromes and other mono-neuropathies. Berlin: Springer; 1997.
    1. Lew HL, Date ES, Pan SS. Sensitivity specificity and variability of nerve conduction velocity measurements in carpal tunnel syndrome. Arch Phys Med Rehabil. 2005;86:12–6.
    1. Salerno DF, Franzblau A, Werner RA, Bromberg MB, Armstrong TJ, Albers JW. Median and ulnar nerve conduction studies among workers Normative values. Muscle Nerve. 1998;21(8):999–1005.
    1. Stetson DS, Silverstein BA, Keyserling WM, Wolfe RA, Albers JW. Median sensory distal amplitude and latency Comparisons between nonexposed managerial/professional employees and industrial workers. Am J Ind Med. 1993;24(2):175–89.
    1. Sunderland S. The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatr. 1976;39(7):615–26.
    1. Knibb W. Health economics in surgery. Surgery. 2009;27:389–93.
    1. Nathan PA, Keniston RC, Meadows KD. Predictive value of nerve conduction measurements at the carpal tunnel. Muscle Nerve. 1993; 16:1377–82.
    1. Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve. 2004;29(515):522.
    1. Boland R, Kiernan M. Assessing the accuracy of a combination of clinical tests for identifying carpal tunnel syndrome. J Clin Neurosci. 2009;16(929):933.
    1. Buchberger W. Radiologic imaging of the carpal tunnel. Eur J Radiol. 1997;25:112–7.
    1. Sarria L, Cabada T, Cozcolluela R. Carpal tunnel syndrome: usefulness of sonography. Eur J Radiol. 2000;10:1920–5.
    1. Wong SM, Griffith JF, Hui AC. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum. 2002;46:1914–21.
    1. Wang LY. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome. Chang Gung Med J . 2008;31:469–76.
    1. Karadag YS, Karadag O, Cicekli E, et al. Severity of carpal tunnel syndrome assessed with high frequency ultrasonography. Rheumatol Int. 2010;30(6):761–5.
    1. Mondelli M, Filippou G, Gallo A. Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome. Arthritis Rheum. 2008;59:357–66.
    1. Schmelzer RE, Della Rocca GJ, Caplin DA. Endoscopic carpal tunnel release a review of 753 cases in 486 patients. Plast Reconstr Surg. 2006;117:177–85.
    1. Cudlip SA, Howe FA, Clifton A, Schwartz MS, Bell BA. Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression. J Neurosurg. 2002;96:1046–51.
    1. Kleindienst A, Hamm B, Hildebrandt G. Diagnosis and staging of carpal tunnel syndrome comparison of magnetic resonance imaging and intra-operative findings. Acta Neurochir Wien. 1966;138:228–33.
    1. Radack DM, Schweitzer ME, Taras J. Carpal tunnel syndrome: are the MR findings a result of population selection bias? Am J Roentgenol. 1997;169:1649–53.
    1. Does MD, Snyder RE. Multiexponential T2 relaxation in degenerating peripheral nerve. Magn Reson Med. 1996;35:207–13.
    1. Jarvik JG, Comstock BA, Heagerty PJ. Magnetic resonance imaging compared with electrodiagnostic studies in patients with suspected carpal tunnel syndrome predicing outcomes function and surgical benefit at 1 year. J Neurosurg. 2008;108(541):550.
    1. Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Amelioration by mecobalamin of subclinical carpal tunnel syndrome involving unaffected limbs in stroke patients. J Neurol Sci. 2005;(231):13–8.
    1. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. (CD003219).Cochrane Database Syst Rev. 2003;(1)
    1. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome Cochrane. (CD001554).Database Systc Rev. 2007;2
    1. Scutt N, Rold CG, Scutt A. Glucocorticoids inhibit tencyte proliferation and tendon progenitor cell recruitment. J Orthop Res . 2006;24:173–82.
    1. Wong MW, Tang YN, Fu SC, Lee KM, Chan KM. Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis. Clin Orthop. 2004;421:277–81.
    1. Tsai WC, Tang FT, Wong MK, Yen HC, Pang JH. Decreased expression of proliferating cell nuclear antigen is associated with dexamethasone inhibition of the proliferation of rat tendon fibroblast. J Rheumatol. 2002;29:2397–402.
    1. Tsai WC, Tang FT, Wong MK, Pang JH. Inhibition of tendon cell migration by dexamethasone is correlated with reduced alpha-smooth muscle actin gene expression a potential mechanism of delayed tendon healing. J Orthop Res. 2003;21:265–71.
    1. Turner A, Kimble F, Gulyas K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg. 2010;80:50–4.
    1. Jung Y, Hohmann TC, Gerneth JA. Diabetic hand syndrome. Metabolism. 1971;20:1008–15.

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