Carpal tunnel syndrome: a practical review

Carpal tunnel syndrome is the most common focal entrapment syndrome. Forceful repetitive activity and vibration may be important workplace risk factors for carpal tunnel syndrome. Although systematic study has suggested that carpal tunnel syndrome is work-related, no clear "dose-response" curve has been found between the amount or severity of work and the incidence or severity of the syndrome. Nocturnal pain is a hallmark of the syndrome, and Phalen's test, the carpal compression test and the Flick test are useful indicators of the diagnosis. The most commonly used confirmatory test is the nerve conduction study, with or without electromyography. The primary care physician can treat many cases successfully with simple ergonomic modifications, splinting and steroid injections. Surgical therapy is reserved for recalcitrant cases and patients with more severe nerve impingement. In addition to traditional open procedures, carpal tunnel release may be performed endoscopically.