Diagnosis
Carpal tunnel syndrome
Compression of the median nerve resulting in pain along the distribution of the nerve.
Also known as: Median nerve compression, Median nerve entrapment
Etiology
Cause
Idiopathic
Overuse
Fibroma
Lipoma
Ganglion cyst
Tenosynovitis
Rheumatoid arthritis
Trauma
Edema due to pregnancy
Thyroid disease
Amyloid disease
Gout
Pathophysiology [kir]
Compression and traction of the median nerve --> increased pressure
Obstruction of venous outflow --> localized edema
Impairment of the intraneural microcirculation --> inflammation
Damage to the structural integrity --> loss of function
Sensory fibers are often affected before motor fibers
Risk factors [kir]
Dislocation or subluxation of the carpus
Fractures or skewed consolidation of the distal radius
Wrist arthrosis, inflammatory arthritis, and infectious arthritis
Acromegaly
Cysts or tumors within the tunnel
Pregnancy
Menopause
Obesity
Kidney failure
Hypothyroidism
Use of oral contraceptives
Congestive heart failure
Diabetes
Alcoholism
Vitamin deficiency or toxicity
Exposure to toxins
Epidemiology
Incidence per 100.000 [trb][wsz][vud][tbd][g6o][6ba]
Symptoms & findings
Symptoms
Clinical findings
Anamneses
None listed.
Localized findings
Approach
Blood test
Thyroid test
Serum glucose
Uric acid level
Neurography
Treatment
Weight-loss program
Avoid exercises that puts strain on the wrists (biking)
Wrist splints with the wrist joint in neutral or slight extension (to be worn at nighttime for a minimum of 3-4 wk) have some evidence for efficacy [2al]
Steroid injection
Surgical release of the transverse ligament
Differential diagnoses
Carpometacarpal arthritis of thumb, Cervical radiculopathy, Diabetes mellitus, Flexor carpi radialis tenosynovitis, Ganglion, Leporsy, Lyme disease, Multiple sclerosis, Polyneuropathy, Raynaud phenomenon, Raynauds syndrome, Stroke, Thoracic outlet syndrome, Ulnar tunnel syndrome, Wrist arthritis
References
[1] Sevy JO, Sina RE, Varacallo MA. Carpal Tunnel Syndrome. [Updated 2023 Oct 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/
[2] Mondelli et al. Carpal tunnel syndrome incidence in a general population. Neurology. 2002 Jan 22;58(2):289-94.
[3] Mattioli et al. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status. BMC Public Health 8, 374 (2008).
[4] Mattioli et al. Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy. Occup Environ Med. 2009 May;66(5):299-304.
[5] Tadjerbashi et al. Incidence of referred carpal tunnel syndrome and carpal tunnel release surgery in the general population: Increase over time and regional variations. J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019825572.
[6] Lane et al. Serious postoperative complications and reoperation after carpal tunnel decompression surgery in England: a nationwide cohort analysis. Lancet Rheumatol. 2020 Sep 30;3(1):e49-e57.
[7] Atroshi et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999, 282: 153-158.
[8] http://emedicine.medscape.com/article/327330 (2014-01-02); [Medscape]