Carpal Tunnel Syndrome

The Most Frequent Entrapment Neuropathy of the Upper Limb

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and is characterized by numbness and tingling of the radial 3½ digits. It is found in one percent of the general population and increased incidence is noted in women, the elderly and pregnant patients. Risk factors for carpal tunnel syndrome include diabetes mellitus, obesity, smoking, hypothyroidism, renal failure as well as rheumatoid arthritis.

Pathophysiology

This is a condition characterized by tingling and numbness of the hand due to compression of the median nerve that passes through the carpal tunnel located at the base of the hand.

Investigations

Nerve conduction study is routinely done to confirm the diagnosis.

Treatment

Conservative treatments such as night splints and activity modifications are widely accepted first-line therapies for mild CTS. Nerve gliding exercises may be helpful for mild to moderate symptoms. Avoidance of carrying heavy loads and repetitive hand motions are important.

Surgical Options 

Surgical release of the carpal tunnel is indicated when conservative measures have not managed to relieve the patient’s symptoms or when the compression is severe enough. Open carpal tunnel release (OCTR) and endoscopic carpal tunnel releases (ECTR) are such options.