Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis) (original) (raw)

Carpal tunnel syndrome - anatomical and clinical correlations

Folia medica Cracoviensia, 2013

Carpal tunnel syndrome (CTS) is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed. Common symptoms of CTS involve the hand and result from compression of the median nerve within the carpal tunnel. In general, CTS develops when the tissues around the median nerve irritate or compress on the nerve along its course through the carpal tunnel, however often it is very difficult to determine cause of CTS. Proper treatment (conservative or surgical) usually can relieve the symptoms and restore normal use of the wrist and hand.

Carpal Tunnel Syndrome (Diagnosis and Management)

JPHV (Journal of Pain, Vertigo and Headache), 2021

Carpal Tunnel Syndrome (CTS) is a neuropathy disease that affects the median nerve with an incidence of around 90%. Carpal Tunnel Syndrome appears in 3.8% of the general population, with the highest prevalence occurring in women. There are several risk factors associated with CTS, namely medical and non-medical factors. The mechanism of carpal tunnel syndrome until now is still very complex and is not known with certainty, but compression and traction factors in the median nerve are thought to be the most common cause of CTS. Carpal Tunnel Syndrome can manifest clinically with subjective signs such as paresthesia, proprioceptive changes, and paresis, as well as objective signs, such as changes in motor sensitivity and function, positive Tinel and Phallen tests, and thenar muscle atrophy. The diagnosis of Carpal Tunnel Syndrome is based on the classic symptoms of pain, numbness, tingling, and/or burning sensation in the distribution of the median nerve in the hand, as well as the abn...

Carpal tunnel syndrome: Diagnosis and surgical treatment

Health, 2012

Carpal tunnel syndrome (CTS) is a compressive idiopathic neuropathy, most commonly affecting the median nerve in the upper extremity. CTS have high prevalence, with up to 70% of cases in women aged between 45 and 60 years. Typical manifestations ...

Causes of Carpal Tunnel syndrome (CTS

Pakistan Journal Of Neurological Surgery, 2014

Objective: To know about the pathological causes of carpal tunnel syndrome. Materials and Methods: This is retrospective cross sectional study on the patients operated by the senior author at his private clinic between January 2008 and March 2014. All the patients operated for carpal tunnel syndrome during the study period were included while those managed conservatively were excluded from the study. Preoperatively all patients had undergone Nerve conduction studies and the procedure was performed under local anaesthesia. The pathology responsible for causing CTS was noted. Results: A total of 73 patients were operated for CTS during the study period by the senior author. There were 18 males and 55 females with a male to female ratio approaching 3.0:1. The age range was from 24-58 years with a mean age of 43.6 ± 4 years. The pathology was hypertrophied transverse carpal ligament in 66 (90%) cases, abnormal vessels in 1 (1%), neuroma in 1 (1%), fracture distal end of the radius in 2 (5%), ganglion compressing the nerve in 1 (1%), post cellulitis in 1 (1%) and direct trauma to the nerve in 1 (1%). Conclusion: Thickened ligamentum flavum is the most common cause of carpal tunnel syndrome and space occupying lesion constitute a considerable percent of pathology.

A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment

World Journal of Radiology, 2014

Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anatomy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.

Carpal Tunnel Syndrome: A Review of Literature

Cureus, 2020

Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most frequently reported forms of median nerve compression. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation. The diagnosis of CTS is conducted through medical assessments and electrophysiological testing, although idiopathic CTS is the most typical method of diagnosis for patients suffering from these symptoms. The pathophysiology of CTS involves a combination of mechanical trauma, increased pressure, and ischemic damage to the median nerve within the carpal tunnel. The diagnosis of CTS patients requires the respective medical professional to develop a case history associated with the characteristic signs of CTS. In addition, the doctor may question whether the patients use vibratory objects for their tasks, the parts of the arm where the sensations are felt, or if the patient may already have predisposing factors for CTS incidence. During the diagnosis of CTS, it is essential to note that other conditions may also provide similar symptoms to CTS, thus requiring vigorous diagnosis to assert the medical condition of the patients. Doctors use both non-surgical and surgical treatments when addressing CTS. Non-surgical treatments include wrist splinting, change of working position, medications, and the use of alternative non-vibrating equipment at work. On the other hand, surgical methods include open release and endoscopic surgeries. This review of literature has provided an overview of CTS with an emphasis on anatomy, epidemiology, risk factors, pathophysiology, stages of CTS, diagnosis, and management options.

Carpal tunnel syndrome: pathophysiology and clinical neurophysiology

Clinical Neurophysiology, 2002

Carpal tunnel syndrome (CTS) is a constellation of symptoms associated with compression of the median nerve at the wrist. The pathophysiology of CTS is not fully understood but mechanical aspects of injury within the carpal tunnel are most likely. The issues of ischemia, mechanical trauma, ectopic impulse generation, demyelination, tendonitis, elevated carpal tunnel pressure, mechanical factors, small and large fiber involvement and the variability of symptoms are presented.

Carpal tunnel syndrome: A review

Clinical Rheumatology, 1997

Carpal tunnel syndrome (CTS) is a common problem in daily rheumatologic practice. A study of the National Institute for Occupational Safety and Health estimated a prevalence of 1.55% in the USA population based on self-report from 44,233 households in 1988 (1). Stevens et al report an incidence of 105 per 100,000 (age adjusted rates were 52 for men and 149 for women) for the period 1961 through 1980 examining the medical records in Rochester, Minnesota. The incidence increased to 125 per 100,000 during the 1976 to1980 quinquennium (2). CTS is caused by compression of median nerve (MN) at the level of the wrist as it passes through the carpal tunnel (CT) (fig. 1). Patients complain of painful tingling and numbness in the MN innervated fingers (thumb, index finger, medium finger, and half of the ring finger). Often the pain irradiates up the arm. The symptoms are more intense during the night and on the awakening (3). The patients usually try to find relief by shaking the hand in the air: this is usually referred as flick test and is considered the most valid and reliable clinical sign of CTS (4). Motor complaints include weak grip and a history of dropping objects. Physical findings include sensory loss in the index finger and middle finger, weakness of abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis. In advanced cases wasting of the muscles of the thenar eminence can be found (4). The sensory loss can be better explored by vibrometry than with the pin prick test or the two-point discrimination test. Vibrometry can be used cost-effectively as a screening test for CTS, but is less sensitive than nerve conduction studies (NCS) especialty in the early stages of CTS (5-7). In CTS the sensory loss spares the thenar eminence which is innervated by the palmar cutaneous branch of the MN. Indeed, this branch emerges before the MN enters the CT. If the sensory loss involves the thenar eminence a compression proximal to the CT should be suspected. Exploration of motor impairment may be done by evaluating the abductor pollicis brevis muscle which, among the thenar

Carpal tunnel syndrome: a review of the recent literature

The open orthopaedics journal, 2012

Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging.