This article may be too technical for most readers to understand.(July 2022) |
Carpal tunnel syndrome | |
---|---|
Untreated carpal tunnel syndrome, showing shrinkage (atrophy) of the muscles at the base of the thumb | |
Specialty | Orthopedic surgery, plastic surgery, neurology |
Symptoms | Numbness, tingling in the thumb, index, middle finger, and half of ring finger.[1][2] |
Causes | Compression of the median nerve at the carpal tunnel[1] |
Risk factors | Genetics, work tasks |
Diagnostic method | Based on symptoms, physical examinations, electrodiagnostic tests[2] |
Differential diagnosis | Peripheral neuropathy, Radiculopathy, Plexopathy |
Prevention | None |
Treatment | Wrist splint, corticosteroid injections, surgery[3] |
Frequency | 5–10%[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]
Graham 2587–2593
was invoked but never defined (see the help page).