Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the symptoms and signs characteristic of compressive median neuropathy at the carpal tunnel of the wrist. Compressive median neuropathy is a structural, largely hereditary condition that is usually measurable in both wrists. Most cases of median neuropathy at the carpal tunnel are idiopathic, meaning there is no known cause. Other causes of median nerve compression at the carpal tunnel include bleeding, swelling, and deformity associated with a wrist fracture. Carpal tunnel syndrome can also occur with rheumatoid arthritis, due to the enlarged synovial lining of the tendons causing median nerve compression. The main symptoms are numbness and tingling of the thumb, index finger, middle finger, and the thumb side of the ring finger, as well as pain in the hand and fingers. Symptoms are typically most troublesome at night. Many people sleep with their wrists bent, and the ensuing symptoms may lead to awakening. People wake less often at night if they wear a wrist splint. Untreated, and over years to decades, CTS causes loss of sensitivity, weakness, and shrinkage (atrophy) of the thenar muscles at the base of the thumb. Work-related factors such as vibration, wrist extension or flexion, hand force, and repetitive strain are risk factors for CTS. Other risk factors include being female, obesity, diabetes, rheumatoid arthritis, thyroid disease, and genetics. Diagnosis can be made with a high probability based on characteristic symptoms and signs. It can also be measured with electrodiagnostic tests. Injection of corticosteroids may or may not alleviate symptoms better than simulated (placebo) injections. There is no evidence that corticosteroid injection sustainably alters the natural history of the disease, which seems to be a gradual progression of neuropathy. Surgery to cut the transverse carpal ligament is the only known disease modifying treatment.