Understanding carpal tunnel syndrome

Abstract

domains and have physical and economic consequences, such as absence from work, decreased neurologic function, and high healthcare costs. 3 This article describes the anatomy and pathophysiology of CTS and its treatment options so clinicians can better prepare patients and streamline referrals for improved outcomes. ANATOMYThe carpal tunnel is a narrow space located on the palmar surface that allows the passage of various structures such as the median nerve and various fl exor tendons (Figures 1 and 2). The borders of this tunnel include the fl exor retinaculum (roof), carpal bones (base), the hook of the hamate, pyramidal bone, pisiform bone (ulnar edge), scaphoid and trapezoid bones, as well as the tendon of the fl exor carpi radialis (FCR) muscle forming the radial edge. 11 The tendons passing through the carpal tunnel are the four fl exor digitorum superfi cialis, the four fl exor digitorum profundus, and the fl exor pollicis longus.The median nerve enters the hand through the carpal tunnel and divides into six branches (Table 1). Of these, the recurrent branch supplies the muscles of the thumb, which predominantly help with opposition, including the abductor pollicis brevis, opponens pollicis, and the superfi cial portion of the fl exor pollicis brevis.The proper palmar digital nerves compose the next three branches. These are cutaneous digital branches that innervate both the radial and ulnar sides of the thumb. The fi nal branch innervates the radial side of the index fi nger along with motor innervation to the fi rst lumbrical. The fi nal two branches, the common palmar digital branches, © PROSTOCK-STUDIO/SHUTTERSTOCK.COM C arpal tunnel syndrome (CTS) is the most common entrapment neuropathy, defi ned as nerve damage (specifi cally the median nerve) at narrow passage sites. [1][2][3] The fi rst case reports of compression of the median nerve were published by Paget in 1854. 4 Studies by Phalen in the 1950s became the foundational principles for understanding CTS. 5 The condition tends to affect patients ages 40 to 60 years; prevalence is estimated between 4% and 5% of the population. 6 Various studies have shown that CTS is more common in women than men (2.2 to 5.4 women to 1.1 to 3 men per 1,000 people). 7-10 Short-and long-term effects of these neuropathies span various ABSTRACT Carpal tunnel syndrome (CTS) is an entrapment neuropathy affecting the median nerve. Prevalence is estimated at 4% to 5% of the population. A solid understanding of the anatomy, presentation, and diagnostics is key to effi cient diagnosis and appropriate referral. Both surgical and nonsurgical interventions have led to improved clinical outcomes. Clinicians who have an in-depth knowledge of CTS symptoms and treatment options can prepare patients and streamline referrals for improved patient outcomes.

How effective is local corticosteroid injection in patients with carpal tunnel syndrome?—A Cochrane Review summary with commentary

“…Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in adults 2 . It occurs in 4%–5% of the population 2 .…”

“…Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in adults 2 . It occurs in 4%–5% of the population 2 . It accounts for 90% of all the nerve entrapment syndromes 3 .…”

“…The normal pressure of carpal tunnel varies between 2 and 10 mm Hg 3 . CTS is classically a clinical diagnosis; however, further tests like electrodiagnostic studies and ultrasonography may be done when in doubt, to stage the disease or to rule out other diagnoses 1–5 . Treatment of CTS is broadly classified into surgical and nonsurgical 1,3 .…”

Prevalence of carpal tunnel syndrome among dentists: a systematic review and meta-analysis

“…31 Mainly, the prevalence of CTS is estimated between 4% and 5% of the general middle-aged population. 12 Therefore, we conducted a systematic review and meta-analysis in order to gain a reliable estimation regarding the prevalence of CTS among dentists.…”

Prevalence of carpal tunnel syndrome among dentists: a systematic review and meta-analysis

“…Carpal tunnel syndrome (CTS) is one of the most frequent and well-studied entrapment neuropathies with a prevalence in middle-aged general population estimated at around 4.0% to 5.0%. 12 As per its' pathophysiology, CTS occurs as the median nerve is being compressed and damaged through its passage within the narrow osteofibrous canal (carpal tunnel). 27,34 Among the great variety of symptoms that may occur, CTS is also identified by patients as pain, paraesthesias (especially, during the night) and dysaesthesias in the distribution of the median nerve (in the first three and a half digits of the affected hand), are the predominant ones.…”