Diagnosis and treatment of carpal tunnel syndrome

Carpal tunnel syndrome is a commonly occurring entrapment neuropathy of the median nerve at the wrist. This paper reviews the causes and functional manifestations of this syndrome, as well as the clinical diagnosis and provocative tests that may be useful in establishing it. Surgical results are reliably good and may now be obtained with low morbidity using a variety of minimally invasive techniques performed through limited incisions that involve less extensive exposure than the "classic" open procedure. These include flexor tenosynovectomy without transverse carpal ligament (TCL) division, endoscopic release of the TCL, and subcutaneous TCL division with a two-incision technique. The advantages and disadvantages of these new procedures are examined.