Carpal Tunnel Syndrome

What is carpal tunnel syndrome (CTS)?

• Peripheral nerve entrapment

• Compression of the median nerve

• Occurs as median nerve passes through carpal tunnel

• Produces:

  • Sensory disturbances

  • Motor disturbances

• Findings occur in median nerve distribution

What conditions are associated with carpal tunnel syndrome?

• Repetitive use

• Rheumatoid arthritis

• Pregnancy

• Diabetes

• Cumulative trauma

• Hypothyroidism

• Tumor

• Wrist sprain/fracture

What are the sensory symptoms of carpal tunnel syndrome?

• Paresthesia

• Sensory changes

• Symptoms follow median nerve distribution

• Night pain is common

• Symptoms may radiate into:

  • Upper extremity

  • Shoulder

  • Neck

What motor/functional deficits can occur with carpal tunnel syndrome?

• Hand weakness

• Muscle atrophy

• ↓ Grip strength

• Clumsiness

• ↓ Wrist mobility

What is the initial treatment for carpal tunnel syndrome?

Conservative management first:

• Splinting

• Ergonomic modifications

• Local corticosteroid injections

• Physical therapy

When may surgery be required for carpal tunnel syndrome?

• Severe or persistent CTS

• Failure of conservative treatment

• Surgical treatment:

  • Carpal tunnel release

• Goal → decompress the median nerve