Surgical treatment options for carpal tunnel syndrome

Carpal tunnel syndrome

“…[16][17][18] I also searched Medline, used a personal reference archive, and analysed the computerised records of over 20 000 patients with suspected carpal tunnel syndrome in east Kent signs have been compared with nerve conduction studies as a diagnostic gold standard in many studies. In such studies, Phalen's sign has sensitivity ranging from 10% to 73% and specificity from 55% to 86%.…”

“…The available studies have been well summarised in a series of reviews by the Cochrane Collaboration. [16][17][18][19] Box 1 | Standard symptoms of carpal tunnel syndrome* • Dull, aching discomfort in the hand, forearm, or upper arm • Paraesthesias in the hand • Weakness or clumsiness of the hand • Dry skin, swelling, or colour changes in the hand • Occurrence of any of the above in the median distribution • Provocation of symptoms by sleep • Provocation of symptoms by sustained hand or arm positions • Provocation of symptoms by repetitive actions of the hand or wrist • Mitigation of symptoms by changing hand posture or shaking the wrist *According to the American Academy of Neurology's guidelines Box 2 | Conditions that may be confused with carpal tunnel syndrome • Cervical radiculopathy (especially C6/7)-look for local neck pain on movement and neurological signs outside the territory of the distal median nerve • Ulnar neuropathy-this can also produce nocturnal paraesthesias; the distribution will usually be to the medial side of the hand. • Raynaud's phenomenon-this should be recognisable from a history of symptoms related to cold exposure • Vibration white finger-suspect this if the patient uses vibrating hand tools at work • Osteoarthritis of the metacarpophalangeal joint of the thumb-this can produce a spurious appearance of thenar wasting but not true weakness or sensory deficit • Tendonitis-specific tests may help in diagnosis, such as Finkelstein's test for De Quervain's tenosynovitis • Generalised peripheral neuropathies-these should be recognised from the wider distribution of symptoms and reflex changes • Motor neurone disease-this can present with wasting in one hand but does not produce sensory symptoms • Syringomyelia-features such as prominent loss of temperature sensation in the hands should give a clue • Multiple sclerosis-this should be recognised from the presence of neurological abnormalities disseminated in location and time…”

Carpal Tunnel Syndrome

“…However, it found confl icting evidence as to whether endoscopic release leads to earlier return to work or full activities of daily living. Overall complication rates were similar but endoscopy was associated with more transient nerve sequelae such as numbness, while open surgery resulted in more wound complications (Scholten et al 2004).…”

“…Observational data show that surgical release results in 80-97% of patients noting marked improvement or complete symptomatic relief. The Cochrane review reported that both the standard procedure and endoscopic release appeared to be equally effi cacious and cost-effective in the short term (Scholten et al 2004). However, it found confl icting evidence as to whether endoscopic release leads to earlier return to work or full activities of daily living.…”

Focal Peripheral Neuropathies

“…11 No one technique is clearly superior to another. 12 Thus, patients with mild carpal tunnel should try noninvasive treatment initially, particularly if there is another factor such as pregnancy or hypothyroidism, and then proceed to decompression if symptoms persist. Patients with moderate carpal tunnel syndrome should probably proceed directly to decompression, though a trial of splinting while awaiting surgery might spare some surgery.…”