Carpal tunnel syndrome is the entrapment of the median nerve beneath the tissues in the wrist. It produces a specific set of symptoms and has a number of associated risk factors. It's a common cause of discomfort in the hand. CTS has surgical and non-surgical treatments.
Incidence and Causes
It occurs most frequently in middle-aged women. The syndrome occurs as a result of compression of the median nerve beneath the flexor retinaculum. The flexor retinaculum is a sheath of tough, fibrous tissue below the skin at the wrist. Essentially, any conditions that cause an increase in pressure in this compartment may lead to the development of the syndrome. Common causes are pregnancy, rheumatoid arthritis, trauma and diabetes. Many times, no cause is identified.
Symtpoms
CTS symptoms consist of tingling, numbness and/or pain in the thumb, second, third and half of the fourth fingers. Longstanding carpal tunnel syndrome can result in loss of muscle bulk in the palm of the hand. The symptoms are often worse at nights and may wake people from sleep. As the condition progresses, manual dexterity is affected, making it difficult to perform simple tasks such as combing hair, buttoning a shirt or holding small objects.
Reaching a Diagnosis
The diagnosis is made based on the symptoms and examination findings. The diagnosis may still be in doubt after the examination; a nerve conduction test can be done to confirm it. This test also excludes other causes for the symptoms, such as median nerve problems at a higher level than the wrist.
Treatment
Treatment consists of surgical and non-surgical modalities. Non-surgical modalities are usually attempted first.
A simple wrist splint applied for three to six weeks is often the first measure. Hydrocortisone injections to the wrist may be used as well; they are most often done in pregnant women until delivery, when their symptoms tend to resolve. There's a chance of recurrence of the syndrome after non-surgical treatment.
Surgical treatment involves incising the flexor retinaculum and releasing the pressure in the compartment. This can be achieved via an open method or endoscopically. In the open procedure, a small incision is made in the wrist and the surgeon operates under direct vision. In the endoscopic technique, the same operation is done but via the insertion of a small camera into the wrist to visualize the area. Complications from either method are rare.
Prognosis
Carpal tunnel syndrome is a relatively common condition that can be easily treated. Surgery offers a cure for the condition with few risks.
References
- Crawford, J. et al, Outline of Orthopaedics
- American Academy of Orthopaedic Surgeons Work Group Panel. AAOS Clinical Guidelines on the Treatment of Carpal Tunnel Syndrome. AAOS Now October 2008 Issue (10/09/08).
