Carpal tunnel syndrome: a review

Area of Science:

• Neurology
• Orthopedics
• Hand Surgery

Background:

• Carpal tunnel syndrome (CTS) presents with characteristic numbness, tingling, and pain in the median nerve distribution.
• Thenar weakness and autonomic dysfunction are indicative of advanced CTS.
• Accurate diagnosis relies heavily on clinical presentation and physical examination findings.

Purpose of the Study:

• To outline the diagnostic criteria and management strategies for carpal tunnel syndrome.
• To emphasize the importance of clinical evaluation over electrodiagnostic studies alone.
• To discuss treatment options ranging from conservative measures to surgical intervention.

Main Methods:

• Clinical history taking and physical examination, including provocative tests like wrist flexion and percussion tests.
• Nerve conduction velocity (NCV) and electromyography (EMG) studies for complex or differential diagnoses.
• Evaluation of treatment outcomes for conservative (splinting, steroid injections) and surgical (open or endoscopic decompression) approaches.

Main Results:

• A negative NCV/EMG study does not rule out CTS.
• Conservative treatment can provide long-term symptom relief for some patients.
• Surgical decompression is often indicated for patients unresponsive to conservative care or with prolonged symptoms.

Conclusions:

• The diagnosis of carpal tunnel syndrome is primarily based on patient history and physical examination.
• Conservative management is the initial treatment of choice.
• Surgical decompression is a viable option for refractory cases and those with significant functional impairment.