Journal Reading

Carpal tunnel syndrome: clinical features,

diagnosis, and management

Luca Padua, Daniele Coraci, Carmen Erra, Costanza

Pazzaglia, Ilaria Paolasso, Claudia Loreti, Pietro Caliandro,
Lisa D Hobson-Webb

Lancet Neurol 2016; 15: 127384

Department of Geriatrics, Neurosciences and Orthopaedics, Universit
Cattolica del Sacro Cuore, Rome, Italy
 Carpal Tunnel
The carpal tunnel is
formed between the
carpal bones of the
wrist and the transverse
carpal ligament.
Carpal Tunnel Syndrome (CTS) is compression of the
median nerve at the wrist and is the most common
nerve entrapment.
 Epidemiology

Carpal tunnel syndrome has been

reported to affect mostly women
(with mean age of diagnosis about 50
years)
Results of a postal survey of Southern
Sweden showed that the prevalence
of carpal tunnel syndrome was similar
in men and women (male:female ratio
1:14).
However, prevalence was highest in
older women; by age 6574 years, the
prevalence in women was almost four
times higher than in men (51% vs 1
3%, respectively).
 Pathophysiology
The tendons of the hands are wrapped with a lining that
produce a synovial fluid which lubricates the tendons

With repetitive movement of the hand, the lubrication

system may malfunction

This reduction in lubrication results in inflammation and

swelling of the tendon area

Abnormally high carpal tunnel pressures exist in patients

with CTS.

This pressure causes obstruction to venous outflow, back

pressure, oedema formation, and ultimately, ischemia in
the nerve.
 Risk Factor and causes
Smaller carpal tunnel
Trauma
Other medical condition
Occupation
Hormonal changes
 Signs and Symptoms
9

Sensory Motor Signs

Paraesthesia Weakness Edema
Numbness
Tingling
Burning
Thenar
Atrophy
Pain atrophy
Night

Stiffness

Pecina,M.,M., Nemanic,J.,K., Markiewitz.,A.,D. 2008. Tunnel syndromes.

Peripheral nerve compression syndromes. CRC Press.New York.
 Diagnosis
History
Physical Examination
Neurophysiological test
Nerve Conduction Study
Electromyography
Imaging Test
USG
MRI
 Phalens test has 85% in sensitivity and 89% in spesifity
Tinels test has 67% in sensitivity and 68%in spesifity
 Treatment
Non- Surgical Treatment
Education
Immobilization
Oral Medication
Injection
Physical Therapy
Non-surgical treatment
 Open Carpal Tunnel Release
Endoscopic Carpal Tunnel Release
Surgical vs Non surgical Treatment

Surgery

Non-
surgery
 CONCLUSION
General practitioners should be the first point
of contact with CTS patients
Regarding management of CTS, both surgical
and non-surgical interventions can be
beneficial.
Surgical release then being considered for patients
with severe or persistent symptoms.