Carpal Tunnel Syndrome

Carpal tunnel syndrome is a disease resulting in pain in the hand and wrist, numbness in the hand and arm especially at nights, loss of fine motor skills in hands as a result of compressed median nerve that passes down the inside of the hand below the ligament called carpal in the wrist. Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy seen in 1% of the general population, 2% of the adult population, and about 5% of those who frequently use the wrist with repetitive movements. It is 2-5% more common in women than men. It is seen in the dominant hand of women aged 55-65 years, whereas it seen bilaterally in men.

The cause is uncertain in most of the cases.  There is a trauma history in the region of the wrist in 5-10% of the cases.  Repetitive microtraumas due to occupational causes are also other causes.  However, it can also be caused by many systemic diseases such as rheumatoid arthritis, chronic renal failure, diabetes mellitus, gout disease, amyloidosis, and tumours seen in the wrist region.

Patients are generally middle-aged women and have the complaints of pain with burning sensation in the hand and wrist and of numbness in all fingers except small fingers.  Night pain and numbness, which are the early symptoms, awake patients at night; the patient tries to reduce the pain by elevating or shaking the hand.  Often the pain radiates to the elbow and sometimes to the shoulder.  Over time, weak grip strength occurs in the hand.  Late symptoms are loss of muscle tissues of the thumb (Thenar region) developing within days and weakness in the movement the thumb.

An electrophysiological test called EMG is most common test used to diagnose the disease.  The most common misdiagnosed disease is herniated cervical disc, in other words cervical disc herniation.  Carpal Tunnel Syndrome has two types of treatment.  The first one is conservative treatment in mild cases and in patients without electrophysiological pathology.  These are avoiding certain activities, using wrist splints, arranging occupational and daily activities and drug treatment.  Surgical treatment is carried out in patients with advanced disease and electrophysiological pathologies.  Surgical treatment techniques are divided into two as open surgical techniques and closed surgical techniques.

Sources

1- Turkish Neurosurgical Society Books, Basic Neurosurgery Book