Carpal tunnel syndrome: a review

Carpal tunnel syndrome involves classic symptoms of numbness and paresthesias in the radial 3-1/2 digits, most frequently nocturnal, and pain associated with this distribution. Thenar weakness and autonomic dysfunction rarely are seen in this syndrome except in advanced cases. Provocative tests on physical examination such as the wrist flexion test and the local percussion sensitivity test over the median nerve can be extremely helpful in determining and confirming the diagnosis. Nerve conduction velocity and electromyographic studies of the median nerve and its compression can be helpful especially in difficult cases involving a complex differential diagnosis. It has been clearly documented that a negative NCV/EMG study by itself, does not exclude the possibility of carpal tunnel syndrome. The hallmark of the diagnosis remains the history and a careful physical examination. Treatment initially consisting of wrist splint immobilization and steroid injection into the carpal canal can provide initial relief and elimination of symptoms on a long-term basis in several patient groups. Patients without any resolution of symptoms after two to three months of conservative treatment or those with symptoms of greater than one year's duration generally can be considered candidates for surgical decompression of the carpal canal. The likelihood of operative treatment being required for resolution of symptoms is heightened if the patient is involved in daily manual repetitive activities of the hand and/or wrist. Surgical decompression can be accomplished by either a limited open technique or the new endoscopic released technique.(ABSTRACT TRUNCATED AT 250 WORDS)