CARPAL TUNNEL SYNDROME

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 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.[5] There is a belief that CTS manifests as pain with typing or other types of hand use.[6] 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.[7] 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.[8] 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 long hours of computer keyboard use. However, while studies have found associations between some work activities and Carpal Tunnel Syndrome, causality has not been demonstrated.[9] The condition known as Carpal Tunnel Syndrome has had major appearances throughout the years but it was most commonly heard of in the years following World War II.[10] Individuals who had suffered from this condition have been depicted in surgical literature for the mid-19th century.[10] In 1854, Sir James Paget was the first to report median nerve compression at the wrist in a distal radius fracture.[11] Following the early 20th century there were various cases of median nerve compression underneath the transverse carpal ligament.[11] Carpal Tunnel Syndrome was most commonly noted in medical literature in the early 20th century but the first use of the term was noted 1939. Physician Dr. George S. Phalen of the Cleveland Clinic identified the pathology after working with a group of patients in the 1950s and 1960s.[12