Carpal tunnel syndrome or CTS refers to the complex of symptoms and signs as a result of compression of the median nerve as it travels through the carpal tunnel. Common symptoms associated with CTS include pain and paresthesia, and less commonly weakness, in the median nerve distribution. CTS is the most frequent compressive focal mononeuropathy seen in clinical practice.
The pathophysiology of CTS is multifactorial. Increased pressure in the intercarpal canal is thought to play a key role in the development of clinical CTS. Risk factors for CTS include Obesity, Female gender, Coexisting conditions (eg, diabetes, pregnancy, rheumatoid arthritis, hypothyroidism, connective tissue diseases, preexisting median mononeuropathy) and Genetic predisposition.
The role of repetitive hand/wrist use and workplace factors in the development of CTS is also common.
The classic symptom of CTS is pain or paresthesia (numbness and tingling) in a distribution that includes the median nerve territory, with involvement of the first three digits and the radial half of the fourth digit. The symptoms of CTS are typically worse at night and often awaken patients from sleep. Some patients note improvement with these symptoms by shaking or wringing their hands or by placing them under warm running water.
The pain and paresthesia may be localized to the wrist or involve the entire hand.
CTS is a clinical diagnosis. The diagnosis is suspected when the characteristic symptoms and signs are present. The most important of these are nocturnal pain or paresthesia in the distribution of the median nerve.
Electrodiagnostic testing can be helpful to confirm or exclude CTS. It is also useful to gauge severity of nerve compression and to aid in decisions regarding surgical intervention. Imaging studies may be useful for the evaluation of CTS in some cases, if there is concern for a structural abnormality of the wrist.
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Jordan Shankle, PA