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, paresthesias, 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 "Etiology of carpal tunnel syndrome" and "Clinical manifestations and diagnosis of carpal tunnel syndrome".)
The carpal tunnel is a defined anatomic space with the following characteristics [1-3]:
- The dorsal surface is formed by the carpal bones, while the volar surface is formed by the transverse carpal ligament (flexor retinaculum), which attaches ulnarly to the hamate and pisiform, and radially to the trapezium and scaphoid tuberosity (figure 1).
- The antebrachial fascia of the forearm is continuous with the transverse carpal ligament of the palm. The four flexor digitorum profundus tendons, four flexor digitorum superficialis tendons, the flexor pollicis longus tendon, and the median nerve pass within the carpal tunnel (figure 2).
When compression of the nerve occurs, ischemia and mechanical disruption of nerve function may result. Compression induces dysfunctional axonal transport and epidural blood flow due to increased carpal tunnel pressure (CTP) . Pathologic analysis shows edema and thickening of vessel walls within the endoneurium and perineurium, fibrosis, myelin thinning, and nerve fiber degeneration and regeneration [2,4,5].