[The carpal tunnel syndrome (author's transl)]

The carpal tunnel, a narrow space closed distally by the anterior annular ligament of the wrist, and containing flexor tendons and the median nerve, is the most frequent site of tunnel syndromes, compression in the canal leading to medium nerve lesion. The carpal tunnel syndrome usually affects women aged between 40 and 60 years, and presents typically as parasthesia of the fingers, mainly at night, in the regions served by the median nerve, sometimes associated with hypoesthesia and difficulty in movements. Motor disorders, particularly affecting the thumb, occur during the advanced stages. Electrical tests may confirm diagnosis and enable assessment of severity. More than half the cases are idiopathic in nature, presenting as hypertrophy of the annular ligament and fibrous thickening in the canal, but other forms may be observed including those due to wrist injuries, anatomical anomalies, rheumatic affections, or tumours. Associated disorders may be Dupuytren's disease, cubital nerve compression in Guyon's canal, or nodular tendinitis leading to a trigger finger. Surgical treatment is simple and should be employed when medical measures fail. The nerve should therefore be liberated if parasthesia persists after two or three local corticoid infiltrations. After a wide exploratory incision, the nerve is freed along the total length of the canal and up to the distal extremity of the forearm. Results are excellent, 98 p. cent of patients being relieved of their pain. Persistent motor disorders require surgical intervention before amyotrophy and muscle weakness develops.