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Carpal tunnel syndrome.

Jeremy D P Bland1

  • 1East Kent Hospitals NHS Trust, Canterbury, Kings College Hospital NHS Trust, London, UK. jeremy.bland@ekht.nhs.uk

Current Opinion in Neurology
|September 13, 2005
PubMed
Summary

Carpal tunnel syndrome (CTS) involves noninflammatory fibrosis. Ultrasound and nerve conduction studies aid diagnosis, while steroid injections offer an effective alternative treatment for milder CTS cases.

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Area of Science:

  • Orthopedics and Sports Medicine
  • Neurology
  • Radiology

Background:

  • Carpal tunnel syndrome (CTS) causes significant morbidity despite surgical decompression.
  • Etiology of CTS remains unclear, with uncertainties in diagnosis and severity assessment.
  • Optimal non-surgical management for CTS is not fully established.

Purpose of the Study:

  • To review recent advancements in understanding the pathology of CTS.
  • To evaluate current diagnostic modalities and non-surgical treatment options for CTS.
  • To clarify uncertainties surrounding CTS investigation and management.

Main Methods:

  • Review of biochemical studies on surgical specimens of idiopathic CTS.
  • Analysis of ultrasound imaging capabilities for carpal canal contents.
  • Evaluation of diagnostic value of median nerve cross-sectional area measurements.
  • Assessment of nerve conduction studies and advanced imaging techniques (MRI, ultrasound).

Main Results:

  • Idiopathic CTS pathology involves noninflammatory subsynovial connective tissue fibrosis.
  • Biochemical studies suggest regulatory molecules and mechanical stresses contribute to fibrosis.
  • Ultrasound demonstrates accuracy in imaging carpal canal contents; median nerve cross-sectional area measurements show diagnostic potential comparable to nerve conduction studies.
  • Local steroid injections may be an underutilized and effective non-surgical treatment for CTS.

Conclusions:

  • Nerve conduction studies are the primary investigation for suspected CTS.
  • MRI or ultrasound imaging should be considered for diagnostic uncertainty or suspected space-occupying lesions, especially before endoscopic surgery.
  • Local steroid injection is a valid alternative treatment, particularly for milder CTS cases.

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