Syndrome, carpal tunnel

Carpal tunnel syndrome (CTS) is a type of compression neuropathy caused by compression and irritation of the median nerve in the wrist. The nerve is compressed within the carpal tunnel, a bony canal in the palm side of the wrist that provides passage for the median nerve to the hand. The irritation of the median nerve is specifically due to pressure from the transverse carpal ligament. CTS can be due to trauma from repetitive work such as that of supermarket checkers, checkers in other types of stores, assembly line workers, meat packers, typists, wordprocessors, accountants, writers, etc. Other factors predisposing to CTS include obesity, pregnancy, hypothyroidism, arthritis, and diabetes. The symptoms of CTS include numbness and tingling of the hand, wrist pain, a “pins and needles” feeling at night, weakness in the grip and a feeling of incoordination. The diagnosis is suspected based on symptoms, supported by signs on physical examination, and confirmed by nerve conduction testing. Treatment depends on the severity of symptoms and the underlying cause. Early CTS is usually treated by modification of activities, a removable wrist brace and anti-inflammatory medicines. Caught early, CTS is reversible. If numbness and pain continue in the wrist and hand, a cortisone injection into the carpal tunnel can help. Surgery is only indicated if other treatments have failed. In advanced CTS, particularly with profound weakness and muscle atrophy (wasting), surgery is done to avoid permanent nerve damage. The surgical procedure is called a carpal tunnel release. It relieves the pressure exerted on the median nerve within the carpal tunnel. This surgical procedure is performed via a small incision using conventional surgery or a fiberoptic scope (endoscopic carpal tunnel repair).