Management of carpal tunnel syndrome

AbstractThe carpal tunnel syndrome (CTS) is a neuropathy caused by entrapment of the median nerve at the level of the carpal channel, delimitated by the carpal bones and by the transverse carpal ligament.In the median nerve, which runs through the carpal tunnel, there is a pattern of symptoms that emerges. Pain and paresthesia usually arise first, followed by numbness. These early sensory symptoms could occur without any significant changes in nerve conduction velocity, so electrodiagnostic testing is not necessarily accurate in the early stages of nerve degeneration. As time progresses weakness and atrophy are also noticed as motor fibers are affected.The diagnosis of idiopathic CTS is commonly based on medical history, clinical examination and provocative tests. Clinical diagnosis of CTS is usually easy when a classical clinical picture is present but, in many patients, no motor or sensory deficits are observed and the diagnosis is based only on history and subject symptoms.The use of surgical splints for the management of CTS should not be dismissed.Surgery generally provides symptom relief, as evident by both subjective and objective measures, even in advanced cases.Studies indicate that initial management with surgery is also cost-effective, and delays to treat can cause increased disability Therefore, surgical intervention may be beneficial both from a clinical and cost-effective point of view.