Carpal tunnel syndrome: Treatment and prognosis
- Milind J Kothari, DO
Milind J Kothari, DO
- Professor of Neurology
- Penn State College of Medicine
Carpal tunnel syndrome (CTS) refers to the complex of symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesia, and less commonly, weakness in the median nerve distribution. CTS is the most common compressive focal mononeuropathy seen in clinical practice.
This topic review will discuss treatment of CTS. We will also briefly review the etiology, clinical features, and diagnosis of CTS, which are discussed in greater detail separately. (See "Carpal tunnel syndrome: Etiology and epidemiology" and "Carpal tunnel syndrome: Clinical manifestations and diagnosis".)
The carpal tunnel is formed by the transverse carpal ligament (flexor retinaculum) superiorly and the carpal bones inferiorly (figure 1). The median nerve, accompanied by the nine flexor tendons of the forearm musculature, must pass through this anatomic tunnel (figure 2). (See "Carpal tunnel syndrome: Etiology and epidemiology", section on 'Anatomy'.)
The pathophysiology of CTS is multifactorial. Increased pressure in the intracarpal canal is thought to play a key role in the development of clinical CTS. (See "Carpal tunnel syndrome: Etiology and epidemiology", section on 'Pathophysiology'.)
The hallmark of classic CTS is pain or paresthesia (numbness and tingling) in a distribution that includes the median nerve territory, with involvement of the first three digits and the radial half of the fourth digit (figure 3). The symptoms are typically worse at night and characteristically awaken affected patients from sleep. (See "Carpal tunnel syndrome: Clinical manifestations and diagnosis", section on 'Clinical features'.)
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- APPROACH TO MANAGEMENT
- Initial therapy
- Failure of initial nonsurgical therapy
- Failure of surgical decompression
- SURGICAL DECOMPRESSION
- NONSURGICAL TREATMENT OPTIONS
- Wrist splinting
- - Splinting versus surgery
- Glucocorticoid injection
- - Glucocorticoid injection versus surgery
- Oral glucocorticoids
- Other nonsurgical options
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS