COPYRIGHT © by Michaelidou Maria
Dr. Maria Michailidou
CARPAL TUNEL SYNDROME
Carpal tunnel syndrome (CTS) is a median entrapment neuropathy, that causes paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel.It appears to be caused by a combination of genetic and environmental factors.Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools. There is, however, little clinical data to prove that lighter, repetitive tasks can cause carpal tunnel syndrom
The main symptom of CTS is intermittent numbness of the thumb, index, long and radial
half of the ring fingerThe numbness often occurs at night, with the hypothesis that
the wrists are held flexed during sleep. Recent literature suggests that sleep positioning,
such as sleeping on one's side, might be an associated factor.t can be relieved by
wearing a wrist splint that prevents flexion.Long-
Signs and symptoms
People with CTS experience numbness, tingling, or burning sensations in the thumb
and fingers, in particular the index, middle fingers, and radial half of the ring
fingers, which are innervated by the median nerve. Less-
Some posit that median nerve symptoms can arise from compression at the level of the thoracic outlet or the area where the median nerve passes between the two heads of the pronator teres in the forearm,but this is highly debatable. This line of thinking is an attempt to explain pain and other symptoms not characteristic of carpal tunnel syndrome. Carpal tunnel syndrome is a common diagnosis with an objective, reliable, verifiable pathophysiology, whereas thoracic outlet syndrome and pronator syndrome are defined by a lack of verifiable pathophysiology and are usually applied in the context of nonspecific upper extremity pain.
Numbness and paresthesias in the median nerve distribution are the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated.
Most cases of CTS are of unknown causes, or idiopathic.arpal Tunnel Syndrome can
be associated with any condition that causes pressure on the median nerve at the
wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives,
hypothyroidism, arthritis, diabetes, prediabetes (impaired glucose tolerance), and
trauma.Carpal tunnel is also a feature of a form of Charcot-
Other causes of this condition include intrinsic factors that exert pressure within
the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which
include benign tumors such as lipomas, ganglion, and vascular malformation.Carpal
tunnel syndrome often is a symptom of transthyretin amyloidosis-
There is no consensus reference standard for the diagnosis of carpal tunnel syndrome.
A combination of described symptoms, clinical findings, and electrophysiological
testing is used by a majority of hand surgeons. Numbness in the distribution of the
median nerve, nocturnal symptoms, thenar muscle weakness/atrophy, positive Tinel's
sign at the carpal tunnel, and abnormal sensory testing such as two-
Electrodiagnostic testing (electromyography and nerve conduction velocity) can objectively verify the median nerve dysfunction. If these tests are normal, carpal tunnel syndrome is either absent or very, very mild.
Clinical assessment by history taking and physical examination can support a diagnosis of CTS.
Phalen's maneuver is performed by flexing the wrist gently as far as possible, then
holding this position and awaiting symptoms.A positive test is one that results in
numbness in the median nerve distribution when holding the wrist in acute flexion
position within 60 seconds. The quicker the numbness starts, the more advanced the
condition. Phalen's sign is defined as pain and/or paresthesias in the median-
Tinel's sign, a classic — though less sensitive -
Durkan test, carpal compression test, or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms has also been proposed
Generally accepted treatments include: steroids either orally or injected locally, splinting, and surgical release of the transverse carpal ligament. There is no or insufficient evidence for ultrasound, yoga, lasers, B6, and exercise therapy.
Early surgery with carpal tunnel release is indicated where there is clinical evidence of median nerve denervation or a person elects to proceed directly to surgical treatment. The treatment should be switched when the current treatment fails to resolve the symptoms within 2 to 7 weeks. However, these recommendations have sufficient evidence for carpal tunnel syndrome when found in association with the following conditions: diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, and carpal tunnel syndrome in the workplace