Carpal tunnel syndrome

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Carpal Tunnel Syndrome (CTS) is idiopathic median neuropathy at the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel.[1] The risk factors for CTS are primarily genetic rather than environmental.[2] The carpal tunnel is an intentionally tight area and it seems that the variation occasionally tends towards "too tight".

The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger.[3] The numbness usually occurs at night because we tend to sleep with our wrists flexed and is relieved by wearing a wrist splint that prevents flexion.[4] Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction (raising the thumb towards the ceiling with the back of the hand flat against the table).

There is a myth (in the sense of an unproved or false collective belief that is used to justify a social institution) that CTS manifests as pain with typing or other types of hand use.[5] Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.[6]

Palliative treatments for CTS include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.

Carpal Tunnel Syndrome is considered by some to be a form of repetitive stress injury, and as such, is caused by repetitive motions (most famously, from computer keyboard use). However, while studies have found associations between some work activities and Carpal Tunnel Syndrome, causality has not been demonstrated.[7]


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