Carpal tunnel syndrome

Carpal tunnel syndrome is the commonest entrapment neuropathy and is due to combined compression and traction on the median nerve at the wrist. It is often idiopathic. Although spontaneous resolution is possible, the usual natural evolution is slow progression. Diagnosis is mainly clinical depending on symptoms and provocative tests. An electromyogram is recommended preoperatively and in cases of work-related disease. Medical treatment is indicated early on or in cases with no deficit and consists of steroid injection in the canal or a night splint in neutral wrist position. Surgical treatment is by section of the flexor retinaculum and is indicated in resistance to medical treatment, in deficit or acute cases. Mini-invasive techniques such as endoscopic and mini-open approaches to carpal tunnel release with higher learning curves are justified by the shorter functional recovery time compared to classical surgery, but with identical long-term results. The choice depends on the surgeon's preference, patient information, stage of severity, etiology and availability of material. Results are satisfactory in 90% of cases. Nerve recovery depends on the stage of severity as well as general patient factors. Recovery of force takes about 2-3 months after the disappearance of 'pillar pain'. This operation has a benign reputation with a 0.2-0.5% reported neurovascular complication rate.