Carpal tunnel syndrome

For the Kid Koala album, see Carpal Tunnel Syndrome (album).
Carpal tunnel syndrome
Untreated carpal tunnel syndrome, showing shrinkage (atrophy) of the muscles at the base of the thumb
SpecialtyOrthopedic surgery, plastic surgery, neurology
SymptomsNumbness, tingling in the thumb, index, middle finger, and half of ring finger.[1][2]
CausesCompression of the median nerve at the carpal tunnel[1]
Risk factorsGenetics, work tasks
Diagnostic methodBased on symptoms, physical examinations, electrodiagnostic tests[2]
Differential diagnosisPeripheral neuropathy, Radiculopathy, Plexopathy
PreventionNone
TreatmentWrist splint, corticosteroid injections, surgery[3]
Frequency5–10%[4][5]

Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of compression of the median nerve at the carpal tunnel in the wrist. Carpal tunnel syndrome is an idiopathic syndrome but there are environmental, and medical risk factors associated with the condition.[6][1] CTS can affect both wrists.

Other conditions can cause CTS such as wrist fracture or rheumatoid arthritis. After fracture, swelling, bleeding, and deformity compress the median nerve. With rheumatoid arthritis, the enlarged synovial lining of the tendons causes compression.

The main symptoms are pain in the hand, numbness, and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger.[1]

Symptoms are typically most troublesome at night.[2] Many people sleep with their wrists bent, and the ensuing symptoms may lead to awakening.[7] Untreated, and over years to decades, CTS causes loss of sensibility, weakness, and shrinkage (atrophy) of the thenar muscles at the base of the thumb.

Work-related factors such as vibration, wrist extension or flexion, hand force, and repetition are risk factors for CTS. Other than work related causes there are many known risk factors for CTS including being overweight, female, diabetes mellitus, rheumatoid arthritis and thyroid disease, and genetics.[8][9][5][3]

Diagnosis can be made with a high probability based on characteristic symptoms and signs. It can also be measured with electrodiagnostic tests.[10]

People wake less often at night if they wear a wrist splint. Injection of corticosteroids may or may not alleviate better than simulated (placebo) injections.[11][12][13] There is no evidence that corticosteroid injection sustainably alters the natural history of the disease, which seems to be a gradual progression of neuropathy.[11]

Surgery to cut the transverse carpal ligament is the only known disease modifying treatment.[3]

  1. ^ a b c d Burton C, Chesterton LS, Davenport G (May 2014). "Diagnosing and managing carpal tunnel syndrome in primary care". The British Journal of General Practice: The Journal of the Royal College of General Practitioners. 64 (622): 262–263. doi:10.3399/bjgp14X679903. ISSN 1478-5242. PMC 4001168. PMID 24771836.
  2. ^ a b c "Carpal Tunnel Syndrome Fact Sheet". National Institute of Neurological Disorders and Stroke. January 28, 2016. Archived from the original on 3 March 2016. Retrieved 4 March 2016.
  3. ^ a b c American Academy of Orthopaedic Surgeons (February 29, 2016). "Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline". Archived from the original on March 30, 2020. Retrieved March 5, 2016.
  4. ^ Bickel KD (January 2010). "Carpal tunnel syndrome". The Journal of Hand Surgery. 35 (1): 147–152. doi:10.1016/j.jhsa.2009.11.003. PMID 20117319.
  5. ^ a b Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. (November 2016). "Carpal tunnel syndrome: clinical features, diagnosis, and management". The Lancet. Neurology (Review). 15 (12): 1273–1284. doi:10.1016/S1474-4422(16)30231-9. PMID 27751557. S2CID 9991471.
  6. ^ >Genova A, Dix O, Saefan A, Thakur M, Hassan A (March 2020). "Carpal Tunnel Syndrome: A Review of Literature". Cureus. 12 (3): e7333. doi:10.7759/cureus.7333. PMC 7164699. PMID 32313774.
  7. ^ "Carpal Tunnel Syndrome - Symptoms and Treatment - OrthoInfo - AAOS". www.orthoinfo.org. Retrieved 2023-08-18.
  8. ^ Lampainen K, Hulkkonen S, Ryhänen J, Curti S, Shiri R (October 2022). "Is Smoking Associated with Carpal Tunnel Syndrome? A Meta-Analysis". Healthcare. 10 (10): 1988. doi:10.3390/healthcare10101988. PMC 9601480. PMID 36292435.
  9. ^ Shiri R (December 2014). "Hypothyroidism and carpal tunnel syndrome: a meta-analysis". Muscle & Nerve. 50 (6): 879–883. doi:10.1002/mus.24453. PMID 25204641. S2CID 37496158.
  10. ^ Cite error: The named reference Graham 2587–2593 was invoked but never defined (see the help page).
  11. ^ a b Adindu E, Ramtin S, Azarpey A, Ring D, Teunis T (2024-03-28). "Steroid versus placebo injections and wrist splints in patients with carpal tunnel syndrome: a systematic review and network meta-analysis". The Journal of Hand Surgery, European Volume. 49 (10): 1209–1217. doi:10.1177/17531934241240380. ISSN 2043-6289. PMC 11523550. PMID 38546484.
  12. ^ Boyer MI (October 2008). "Corticosteroid injection for carpal tunnel syndrome". The Journal of Hand Surgery. 33 (8): 1414–1416. doi:10.1016/j.jhsa.2008.06.023. PMID 18929212.
  13. ^ Huisstede BM, Randsdorp MS, van den Brink J, Franke TP, Koes BW, Hoogvliet P (August 2018). "Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review". Archives of Physical Medicine and Rehabilitation. 99 (8): 1609–1622.e10. doi:10.1016/j.apmr.2018.03.003. PMID 29626428. S2CID 4683880.