Carpal tunnel syndrome

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By Francine J Vriesendorp MD and Mazen M Dimachkie MD

Carpal tunnel syndrome is the most common entrapment neuropathy with a prevalence of about 270 per 100,000. The etiology is compression of the median nerve in the carpal tunnel. Clinical manifestations consist of intermittent pain, numbness, and tingling in the fingers that is dependent on the position of the hand and wrist and commonly associated with subjective weakness of grip. Diagnosis is made on the basis of clinical complaints and electrodiagnostic studies. Treatment is conservative or surgical depending on the severity of the symptoms. Francine J Vriesendorp MD, Professor of Neurology at Upstate University in Syracuse New York, and Mazen M Dimachkie MD, Associate Professor of Neurology at the University of Texas Medical School in Houston, report that elderly (older than 70 years) patients have more severe clinical and electrophysiological findings preoperatively but do show high satisfaction scores after surgery. Data on carpal tunnel syndrome in pregnancy reveal that about half of the patients remain symptomatic at 6 months after delivery. Endoscopic carpal tunnel release supposedly produces less scarring than open release but is more expensive and precludes visualization of the median nerve proper. Controversy continues about which surgical procedure is the best.

Key Points

  • Carpal tunnel syndrome is the most common entrapment neuropathy.
  • Electrodiagnostic studies have a sensitivity of up to 95% for the diagnosis when detailed studies are performed.
  • In most patients, including elderly patients and patients with diabetes, surgical carpal tunnel release should be considered if conservative measures fail.