WHAT IS Carpal Tunnel Syndrome?
Compression of the median nerve as it enters the wrist is found in 1%-10% of the population (often bilateral) and leads to symptoms of pain, numbness and tingling in the median nerve distribution (see Figures 1 and 2). It is associated with many medical conditions and certain occupations (repetitive forceful motion and non-neutral wrist positions) but there is no established cause and effect relationship.
Figure 1
Figure 2
HOW IS IT DIAGNOSED?
History of pain, numbness and tingling (see Figure 2), often with night time symptoms and the need to “shake/flick the hand” for relief. Abnormal monofilament sensory testing is one of the earliest findings and the most sensitive and specific physical exam test is the Durkan Compression test. Electrodiagnostic studies can confirm conduction delay, quantify the severity and identify potentially confounding diagnoses such as cervical radiculopathy or peripheral neuropathy.
HOW IS Carpal Tunnel Syndrome TREATED?
The strongest evidence for initial treatment includes night splinting (in a neutral wrist position) and nerve gliding exercises. Steroid injections have both diagnostic and therapeutic value. When these treatments fail to provide adequate relief, or the abductor pollicis brevis muscle is denervated, open or endoscopic surgical release of the transverse carpal ligament is indicated. Minimally-invasive endoscopic carpal tunnel release is successful and studies suggest an earlier return of function. When these treatments fail to provide adequate relief, or the abductor pollicis brevis muscle is denervated, open or endoscopic surgical release of the transverse carpal ligament is indicated. Minimally-invasive endoscopic carpal tunnel release is successful and studies suggest an earlier return of function.
WHAT TO DO NEXT?
Start with neutral night splinting and a visit with a certified hand therapist for instruction in nerve and tendon gliding exercises. Consider electrodiagnostic testing if symptoms are long-standing or do not improve with initial treatment.
CTS Testing
Carpal Tunnel Syndrome (summary of Durkan Compression Test on slides 31 & 32)
Journal of Bone & Joint Surgery Article describing Durkan’s compression test