Carpal Tunnel Syndrome
Definition
Compressive neuropathy (damage/dysfunction) of the median nerve within the carpal tunnel.
Symptoms
- Numbness, tingling, pruritus (itching) and paresthesia (pins-and-needles) mostly at night but can progress to daytime symptoms.
- Typically gradual in onset and includes the thumb, index, long and thumb side of ring finger.
- Severe and untreated can result in loss of temperature sensation and thumb weakness.
Pathology
- Many factors can be implicated in compression of the median nerve. It can be acute or chronic (high-energy trauma or low-energy repetitive trauma).
- Genetics may predispose a person to have a smaller, narrow carpal tunnel.
- Other predisposing factors may include hypothyroidism, obesity, rheumatoid arthritis, diabetes, and pregnancy.
Treatment
Non-surgical
- Rest, activity modifications, night splint, ice and NSAIDs (ibuprofen)
- Occupational/Physical Therapy
- Corticosteroid injection
Surgical
- Indicated when non-operative treatment fails.
- The transverse carpal ligament (a.k.a. flexor retinaculum), which makes up the “roof” of the tunnel, is arthroscopically incised (released).