Carpal Tunnel Syndrome - Wheeless' Textbook of Orthopaedics

- Discussion:
- median nerve compression syndrome at the wrist;
- most common form of nerve entrapment;
    - first described by Paget;
           - references: The First Description of Carpal Tunnel Syndrome. James Paget FRS
    - pathophysiology:
- nerve compression may result in ischemia, focal demyelination, decrease in axonal caliber, and finally axonal loss;
- ref: A Histological and Immunohistochemical Study of the Subsynovial Connective Tissue in Idiopathic Carpal Tunnel Syndrome.
- anatomy of carpal tunnel:
- differential dx:
- electrodiagnosis

- Initial Work Up:
- history:
- presence of pain in the wrist and/or fingers and presence of paresthesias in fingers;
- night pain may be especially predictive;
- physical exam:
- differential dx:
- EMG studies
- carpal tunnel injection / median nerve block:
- references:
- The surgical treatment of the carpal-tunnel syndrome correlated with preoperative nerve-conduction studies.
- Carpal tunnel syndrome: An evaluation of the provocative diagnostic tests. J Bone Joint Surg (Am) 68A:735-737, 1986 Gellman H, Gelberman RH, Tan AM, et al:

- Radiographic Studies:
- cross table lateral (for cervical spondylosis)
- carpal tunnel view
- MRI: (indicated w/ atypical CTS, ie. ? tumor, ? anomalous muscle).

- references:
The use of routine wrist radiography in the evaluation of patients with carpal tunnel syndrome.

- Non Operative Treatment:
- carpal tunnel injection / median nerve block:

- Surgical Treatment:
- anatomy of carpal tunnel:
- preoperative considerations:
- goals of surgery:
- eliminate compression by the tenosynovium;
- tenosynovectomy is performed if tissue is bulky, displaces flexor tendons;
- restore the gliding capacity of the nerve
- remove constriction by external epineurium, & liberate fascicles from internal adhesions; (latter two goals are controversial);
- eliminate pain:
- females who do not perform manual labor may not experience as much relief as male patients who do perform manual labor;
- factors influencing surgical results:
- The influence of age on outcome after operation for the carpal tunnel syndrome. P. Porter et al. JBJS-Br Vol 84-B Number 5 July 2002
- Pre-operative factors and treatment outcome following carpal tunnel release.
- Results of treatment of severe carpal tunnel syndrome.
- Surgical Treatment Options:
- open surgical release:
- enodscopic carpal tunnel release
- post op care and complications:
- references:
- Endoscopic versus open carpal tunnel release: A randomized trial.
- A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression.