Carpal tunnel

syndrome

Carpal tunnel syndrome (CTS) is a

medical condition due to compression of
the median nerve as it travels through the
wrist at the carpal tunnel.[1] The main
symptoms are pain, numbness and
tingling in the thumb, index finger, middle
finger and the thumb side of the ring
fingers.[1] Symptoms typically start
gradually and during the night.[2] Pain
may extend up the arm.[2] Weak grip
strength may occur, and after a long
period of time the muscles at the base of
the thumb may waste away.[2] In more
than half of cases, both sides are
affected.[1]
 Carpal tunnel syndrome

Transverse section at the wrist. The median

nerve is colored yellow. The carpal tunnel
consists of the bones and transverse carpal
ligament.
Specialty Orthopedic surgery,
plastic surgery

Symptoms Pain, numbness,

tingling in the thumb,
index, middle finger,
weak grip[1][2]
Causes Compression of the
median nerve at the
carpal tunnel[1]

Risk factors Obesity repetitive wrist

Risk factors Obesity, repetitive wrist
work, pregnancy,
rheumatoid
arthritis[3][4]
Diagnostic method Based on symptoms,
specific physical tests,
electrodiagnostic
tests[2]
Prevention Physical activity[3]

Treatment Wrist splint,

corticosteroid
injections, surgery[3]

Frequency 5–10%[5][6]

Risk factors include obesity, repetitive

wrist work, pregnancy and rheumatoid
arthritis.[3][4] There is tentative evidence
that hypothyroidism increases the risk.[7]
Diabetes mellitus is weakly associated
with CTS.[3][6] The use of birth control
pills does not affect the risk.[3] Types of
work that are associated include
computer work, work with vibrating tools
and work that requires a strong grip.[3]
Diagnosis is suspected based on signs,
symptoms and specific physical tests
and may be confirmed with
electrodiagnostic tests.[2] If muscle
wasting at the base of the thumb is
present, the diagnosis is likely.[3]

Being physically active can decrease the

risk of developing CTS.[3] Symptoms can
be improved by wearing a wrist splint or
with corticosteroid injections.[3] Taking
NSAIDs or gabapentin does not appear
to be useful.[3] Surgery to cut the
transverse carpal ligament is effective
with better results at a year compared to
non surgical options.[3] Further splinting
after surgery is not needed.[3] Evidence
does not support magnet therapy.[3]

About 5% of people in the United States

have carpal tunnel syndrome.[5] It usually
begins in adulthood, and women are
more commonly affected than men.[2] Up
to 33% of people may improve without
specific treatment over approximately a
year.[1] Carpal tunnel syndrome was first
fully described after World War II.[8]

Signs and symptoms

Untreated carpal tunnel syndrome, showing how the
muscles at the base of the thumb have wasted away
(atrophied)

People with CTS experience numbness,

tingling, or burning sensations in the
thumb and fingers, in particular the index
and middle fingers and radial half of the
ring finger, because these receive their
sensory and motor function (muscle
control) from the median nerve. Ache
and discomfort can possibly be felt more
proximally in the forearm or even the
upper arm.[9] Less-specific symptoms
may include pain in the wrists or hands,
loss of grip strength,[10] and loss of
manual dexterity.[11]

Some suggest that median nerve

symptoms can arise from compression
at the level of the thoracic outlet or the
area where the median nerve passes
between the two heads of the pronator
teres in the forearm,[12] although this is
debated.

Numbness and paresthesias in the

median nerve distribution are the
hallmark neuropathic symptoms (NS) of
carpal tunnel entrapment syndrome.[6]
Weakness and atrophy of the thumb
muscles may occur if the condition
remains untreated, because the muscles
are not receiving sufficient nerve
stimulation.[6] Discomfort is usually
worse at night and in the morning.

Causes

Anatomy of the carpal tunnel, showing the median

nerve passing through the tight space it shares with
the finger tendons
Most cases of CTS are of unknown
cause.[13] Carpal tunnel syndrome can be
associated with any condition that
causes pressure on the median nerve at
the wrist. Some common conditions that
can lead to CTS include obesity,
hypothyroidism, arthritis, diabetes,
prediabetes (impaired glucose
tolerance), and trauma.[14] Genetics play
a role.[15] The use of birth control pills
does not affect the risk.[3] Carpal tunnel
is a feature of a form of Charcot-Marie-
Tooth syndrome type 1 called hereditary
neuropathy with susceptibility to
pressure palsies.
Other causes of this condition include
intrinsic factors that exert pressure
within the tunnel, and extrinsic factors
(pressure exerted from outside the
tunnel), which include benign tumors
such as lipomas, ganglion, and vascular
malformation.[16] Severe carpal tunnel
syndrome often is a symptom of
transthyretin amyloidosis-associated
polyneuropathy and prior carpal tunnel
syndrome surgery is very common in
individuals who later present with
transthyretin amyloid-associated
cardiomyopathy, suggesting that
transthyretin amyloid deposition may
cause carpal tunnel syndrome in these
people.[17]
The median nerve can usually move up to
9.6 mm to allow the wrist to flex, and to a
lesser extent during extension.[18] Long-
term compression of the median nerve
can inhibit nerve gliding, which may lead
to injury and scarring. When scarring
occurs, the nerve will adhere to the tissue
around it and become locked into a fixed
position, so that less movement is
apparent.[19]

Normal pressure of the carpal tunnel has

been defined as a range of 2–10 mm,
and wrist flexion increases this pressure
8-fold, while extension increases it 10-
fold.[18] Repetitive flexion and extension
in the wrist significantly increase the fluid
pressure in the tunnel through thickening
of the synovial tissue that lines the
tendons within the carpal tunnel.[20]

Work related

The international debate regarding the

relationship between CTS and repetitive
motion in work is ongoing. The
Occupational Safety and Health
Administration (OSHA) has adopted rules
and regulations regarding cumulative
trauma disorders. Occupational risk
factors of repetitive tasks, force, posture,
and vibration have been cited. The
relationship between work and CTS is
controversial; in many locations, workers
diagnosed with carpal tunnel syndrome
are entitled to time off and
compensation.[21][22]

Some speculate that carpal tunnel

syndrome is provoked by repetitive
movement and manipulating activities
and that the exposure can be cumulative.
It has also been stated that symptoms
are commonly exacerbated by forceful
and repetitive use of the hand and wrists
in industrial occupations,[23] but it is
unclear as to whether this refers to pain
(which may not be due to carpal tunnel
syndrome) or the more typical numbness
symptoms.[24]
A review of available scientific data by
the National Institute for Occupational
Safety and Health (NIOSH) indicated that
job tasks that involve highly repetitive
manual acts or specific wrist postures
were associated with incidents of CTS,
but causation was not established, and
the distinction from work-related arm
pains that are not carpal tunnel
syndrome was not clear. It has been
proposed that repetitive use of the arm
can affect the biomechanics of the upper
limb or cause damage to tissues. It has
also been proposed that postural and
spinal assessment along with ergonomic
assessments should be included in the
overall determination of the condition.
Addressing these factors has been found
to improve comfort in some studies.[25] A
2010 survey by NIOSH showed that 2/3
of the 5 million carpal tunnel cases in the
US that year were related to work.[26]
Women have more work-related carpal
tunnel syndrome than men.[27]

Speculation that CTS is work-related is

based on claims such as CTS being
found mostly in the working adult
population, though evidence is lacking
for this. For instance, in one recent
representative series of a consecutive
experience, most patients were older and
not working.[28] Based on the claimed
increased incidence in the workplace,
arm use is implicated, but the weight of
evidence suggests that this is an
inherent, genetic, slowly but inevitably
progressive idiopathic peripheral
mononeuropathy.[29]

Associated conditions

A variety of patient factors can lead to

CTS, including heredity, size of the carpal
tunnel, associated local and systematic
diseases, and certain habits.[30] Non-
traumatic causes generally happen over
a period of time, and are not triggered by
one certain event. Many of these factors
are manifestations of physiologic
aging.[31]
Examples include:

Rheumatoid arthritis and other

diseases that cause inflammation of
the flexor tendons.
With hypothyroidism, generalized
myxedema causes deposition of
mucopolysaccharides within both the
perineurium of the median nerve, as
well as the tendons passing through
the carpal tunnel.
During pregnancy women experience
CTS due to hormonal changes (high
progesterone levels) and water
retention (which swells the synovium),
which are common during pregnancy.
Previous injuries including fractures of
the wrist.
Medical disorders that lead to fluid
retention or are associated with
inflammation such as: inflammatory
arthritis, Colles' fracture, amyloidosis,
hypothyroidism, diabetes mellitus,
acromegaly, and use of corticosteroids
and estrogens.
Carpal tunnel syndrome is also
associated with repetitive activities of
the hand and wrist, in particular with a
combination of forceful and repetitive
activities[14]
Acromegaly causes excessive
secretion of growth hormones. This
causes the soft tissues and bones
around the carpel tunnel to grow and
compress the median nerve.[32]
Tumors (usually benign), such as a
ganglion or a lipoma, can protrude into
the carpal tunnel, reducing the amount
of space. This is exceedingly rare (less
than 1%).
Obesity also increases the risk of CTS:
individuals classified as obese (BMI >
29) are 2.5 times more likely than
slender individuals (BMI < 20) to be
diagnosed with CTS.[33]
Double-crush syndrome is a debated
hypothesis that compression or
irritation of nerve branches
 contributing to the median nerve in the
neck, or anywhere above the wrist,
increases sensitivity of the nerve to
compression in the wrist. There is little
evidence, however, that this syndrome
really exists.[34]
Heterozygous mutations in the gene
SH3TC2, associated with Charcot-
Marie-Tooth, confer susceptibility to
neuropathy, including the carpal tunnel
syndrome.[35]

Pathophysiology
The carpal tunnel is an anatomical
compartment located at the base of the
palm. Nine flexor tendons and the
median nerve pass through the carpal
tunnel that is surrounded on three sides
by the carpal bones that form an arch.
The median nerve provides feeling or
sensation to the thumb, index finger, long
finger, and half of the ring finger. At the
level of the wrist, the median nerve
supplies the muscles at the base of the
thumb that allow it to abduct, move away
from the other four fingers, as well as
move out of the plane of the palm. The
carpal tunnel is located at the middle
third of the base of the palm, bounded by
the bony prominence of the scaphoid
tubercle and trapezium at the base of the
thumb, and the hamate hook that can be
palpated along the axis of the ring finger.
From the anatomical position, the carpal
tunnel is bordered on the anterior surface
by the transverse carpal ligament, also
known as the flexor retinaculum. The
flexor retinaculum is a strong, fibrous
band that attaches to the pisiform and
the hamulus of the hamate. The proximal
boundary is the distal wrist skin crease,
and the distal boundary is approximated
by a line known as Kaplan's cardinal
line.[36] This line uses surface landmarks,
and is drawn between the apex of the
skin fold between the thumb and index
finger to the palpated hamate hook.[37]
The median nerve can be compressed by
a decrease in the size of the canal, an
increase in the size of the contents (such
as the swelling of lubrication tissue
around the flexor tendons), or both.[38]
Since the carpal tunnel is bordered by
carpal bones on one side and a ligament
on the other, when the pressure builds up
inside the tunnel, there is nowhere for it
to escape and thus it ends up pressing
up against and damaging the median
nerve. Simply flexing the wrist to 90
degrees will decrease the size of the
canal.

Compression of the median nerve as it

runs deep to the transverse carpal
ligament (TCL) causes atrophy of the
thenar eminence, weakness of the flexor
pollicis brevis, opponens pollicis,
abductor pollicis brevis, as well as
sensory loss in the digits supplied by the
median nerve. The superficial sensory
branch of the median nerve, which
provides sensation to the base of the
palm, branches proximal to the TCL and
travels superficial to it. Thus, this branch
spared in carpal tunnel syndrome, and
there is no loss of palmar sensation.[39]

Diagnosis
There is no consensus reference
standard for the diagnosis of carpal
tunnel syndrome. A combination of
described symptoms, clinical findings,
and electrophysiological testing may be
used. Correct diagnosis involves
identifying if symptoms matches the
distribution pattern of the median nerve
(which does not normally include the 5th
digit).

CTS work up is the most common

referral to the electrodiagnostic lab.
Historically, diagnosis has been made
with the combination of a thorough
history and physical examination in
conjunction with the use of
electrodiagnostic (EDX) testing for
confirmation. Additionally, evolving
technology has included the use of
ultrasonography in the diagnosis of CTS.
However, it is well established that
physical exam provocative maneuvers
lack both sensitivity and specificity.
Furthermore, EDX cannot fully exclude
the diagnosis of CTS due to the lack of
sensitivity. A Joint report published by
the American Association of
Neuromuscular and Electrodiagostic
Medicine (AANEM), the American
Academy of Physical Medicine and
Rehabilitation (AAPM&R) and the
American Academy of Neurology defines
practice parameters, standards and
guidelines for EDX studies of CTS based
on an extensive critical literature review.
This joint review concluded median and
sensory nerve conduction studies are
valid and reproducible in a clinical
laboratory setting and a clinical
diagnosis of CTS can be made with a
sensitivity greater than 85% and
specificity greater than 95%. Given the
key role of electrodiagnostic testing in
the diagnosis of CTS, The American
Association of Neuromuscular &
Electrodiagnostic Medicine has issued
evidence-based practice guidelines, both
for the diagnosis of carpal tunnel
syndrome.

Numbness in the distribution of the

median nerve, nocturnal symptoms,
thenar muscle weakness/atrophy,
positive Tinel's sign at the carpal tunnel,
and abnormal sensory testing such as
two-point discrimination have been
standardized as clinical diagnostic
criteria by consensus panels of
experts.[40][41] Pain may also be a
presenting symptom, although less
common than sensory disturbances.

Electrodiagnostic testing
(electromyography and nerve conduction
velocity) can objectively verify the
median nerve dysfunction. Normal nerve
conduction studies, however, do not
exclude the diagnosis of CTS. Clinical
assessment by history taking and
physical examination can support a
diagnosis of CTS. If clinical suspicion of
CTS is high, treatment should be initiated
despite normal electrodiagnostic testing.
Physical exam

Although widely used, the presence of a

positive Phalen test, Tinel sign, Flick sign,
or upper limb nerve test alone is not
sufficient for diagnosis.[3]

Phalen's maneuver is performed by

flexing the wrist gently as far as
possible, then holding this position and
awaiting symptoms.[42] A positive test
is one that results in numbness in the
median nerve distribution when
holding the wrist in acute flexion
position within sixty seconds. The
quicker the numbness starts, the more
advanced the condition. Phalen's sign
is defined as pain or paresthesias in
the median-innervated fingers with one
minute of wrist flexion. Only this test
has been shown to correlate with CTS
severity when studied prospectively.[30]
The test characteristics of Phalen's
maneuver have varied across studies
ranging from 42–85% sensitivity and
54–98% specificity.[6]
Tinel's sign is a classic test to detect
median nerve irritation. Tinel's sign is
performed by lightly tapping the skin
over the flexor retinaculum to elicit a
sensation of tingling or "pins and
needles" in the median nerve
distribution. Tinel's sign (pain or
paresthesias of the median-innervated
fingers with percussion over the
median nerve), depending on the study,
has 38–100% sensitivity and 55–100%
specificity for the diagnosis of CTS.[6]
Durkan test, carpal compression test, or
applying firm pressure to the palm over
the nerve for up to 30 seconds to elicit
symptoms has also been
proposed.[43][44]
Hand elevation test The hand elevation
test is performed by lifting both hands
above the head, and if symptoms are
reproduced in the median nerve
distribution within 2 minutes,
considered positive. The hand
elevation test has higher sensitivity
 and specificity than Tinel's test,
Phalen's test, and carpal compression
test. Chi-square statistical analysis has
shown the hand elevation test to be as
effective, if not better than, Tinel's test,
Phalen's test, and carpal compression
test.[45]

As a note, a person with true carpal

tunnel syndrome (entrapment of the
median nerve within the carpal tunnel)
will not have any sensory loss over the
thenar eminence (bulge of muscles in the
palm of hand and at the base of the
thumb). This is because the palmar
branch of the median nerve, which
innervates that area of the palm,
branches off of the median nerve and
passes over the carpal tunnel.[46] This
feature of the median nerve can help
separate carpal tunnel syndrome from
thoracic outlet syndrome, or pronator
teres syndrome.

Other conditions may also be

misdiagnosed as carpal tunnel
syndrome. Thus, if history and physical
examination suggest CTS, patients will
sometimes be tested
electrodiagnostically with nerve
conduction studies and
electromyography. The role of
confirmatory nerve conduction studies is
controversial.[6] The goal of
electrodiagnostic testing is to compare
the speed of conduction in the median
nerve with conduction in other nerves
supplying the hand. When the median
nerve is compressed, as in CTS, it will
conduct more slowly than normal and
more slowly than other nerves. There are
many electrodiagnostic tests used to
make a diagnosis of CTS, but the most
sensitive, specific, and reliable test is the
Combined Sensory Index (also known as
the Robinson index).[47] Electrodiagnosis
rests upon demonstrating impaired
median nerve conduction across the
carpal tunnel in context of normal
conduction elsewhere. Compression
results in damage to the myelin sheath
and manifests as delayed latencies and
slowed conduction velocities [30]
However, normal electrodiagnostic
studies do not preclude the presence of
carpal tunnel syndrome, as a threshold of
nerve injury must be reached before
study results become abnormal and cut-
off values for abnormality are variable.[41]
Carpal tunnel syndrome with normal
electrodiagnostic tests is very, very mild
at worst.

The role of MRI or ultrasound imaging in

the diagnosis of carpal tunnel syndrome
is unclear.[48][49][50] Their routine use is
not recommended.[3]

Differential diagnosis
There are few disorders on the
differential diagnosis for carpal tunnel
syndrome. Cervical radiculopathy can be
mistaken for carpal tunnel syndrome
since it can also cause abnormal or
painful sensations in the hands and
wrist.[6] In contrast to carpal tunnel
syndrome, the symptoms of cervical
radiculopathy usually begins in the neck
and travels down the affected arm and
may be worsened by neck movement.[6]
Electromyography and imaging of the
cervical spine can help to differentiate
cervical radiculopathy from carpal tunnel
syndrome if the diagnosis is unclear.[6]
Carpal tunnel syndrome is sometimes
applied as a label to anyone with pain,
numbness, swelling, or burning in the
radial side of the hands or wrists. When
pain is the primary symptom, carpal
tunnel syndrome is unlikely to be the
source of the symptoms.[24] As a whole,
the medical community is not currently
embracing or accepting trigger point
theories due to lack of scientific evidence
supporting their effectiveness.

Prevention
Carpal tunnel prevention stretch

Suggested healthy habits such as

avoiding repetitive stress, work
modification through use of ergonomic
equipment (mouse pad, taking proper
breaks, using keyboard alternatives
(digital pen, voice recognition, and
dictation), and have been proposed as
methods to help prevent carpal tunnel
syndrome. The potential role of B-
vitamins in preventing or treating carpal
tunnel syndrome has not been
proven.[51][52]

There is little or no data to support the

concept that activity adjustment prevents
carpal tunnel syndrome.[53] The evidence
for wrist rest is debated.[54]

There is also little research supporting

that ergonomics is related to CTS.[55] Due
to risk factors for hand and wrist
dysfunction being multifactorial and very
complex it is difficult to assess the true
physical factors of CTS.[56]

Stretches and isometric exercises will aid

in prevention for persons at risk.
Stretching before the activity and during
breaks will aid in alleviating tension at
the wrist.[57] Place the hand firmly on a
flat surface and gently press for a few
seconds to stretch the wrist and fingers.
An example for an isometric exercise of
the wrist is done by clenching the fist
tightly, releasing and fanning out
fingers.[57] None of these stretches or
exercises should cause pain or
discomfort.

Biological factors such as genetic

predisposition and anthropometric
features had significantly stronger causal
association with carpal tunnel syndrome
than occupational/environmental factors
such as repetitive hand use and stressful
manual work.[53] This suggests that
carpal tunnel syndrome might not be
preventable simply by avoiding certain
activities or types of work/activities.
Treatment
Generally accepted treatments include:
physiotherapy, steroids either orally or
injected locally, splinting, and surgical
release of the transverse carpal
ligament.[58] Limited evidence suggests
that gabapentin is no more effective than
placebo for CTS treatment.[6] There is
insufficient evidence for therapeutic
ultrasound, yoga, acupuncture, low level
laser therapy, vitamin B6, and
exercise.[6][58] Change in activity may
include avoiding activities that worsen
symptoms.[15]

The American Academy of Orthopedic

Surgeons recommends proceeding
conservatively with a course of
nonsurgical therapies tried before
release surgery is considered.[59] A
different treatment should be tried if the
current treatment fails to resolve the
symptoms within 2 to 7 weeks. Early
surgery with carpal tunnel release is
indicated where there is evidence of
median nerve denervation or a person
elects to proceed directly to surgical
treatment.[59] Recommendations may
differ when carpal tunnel syndrome is
found in association with the following
conditions: diabetes mellitus, coexistent
cervical radiculopathy, hypothyroidism,
polyneuropathy, pregnancy, rheumatoid
arthritis, and carpal tunnel syndrome in
the workplace.[59]

Splints

A rigid splint can keep the wrist straight

A different type of rigid splint used in carpal tunnel

syndrome.
The importance of wrist braces and
splints in the carpal tunnel syndrome
therapy is known, but many people are
unwilling to use braces. In 1993, The
American Academy of Neurology
recommend a non-invasive treatment for
the CTS at the beginning (except for
sensitive or motor deficit or grave report
at EMG/ENG): a therapy using splints
was indicated for light and moderate
pathology.[60] Current recommendations
generally don't suggest immobilizing
braces, but instead activity modification
and non-steroidal anti-inflammatory
drugs as initial therapy, followed by more
aggressive options or specialist referral if
symptoms do not improve.[61][62]
Many health professionals suggest that,
for the best results, one should wear
braces at night and, if possible, during
the activity primarily causing stress on
the wrists.[63][64]

Corticosteroids

Corticosteroid injections can be effective

for temporary relief from symptoms
while a person develops a long-term
strategy that fits their lifestyle.[65] This
form of treatment is thought to reduce
discomfort in those with CTS due to its
ability to decrease median nerve
swelling.[6] The use of ultrasound while
performing the injection is more
expensive but leads to faster resolution
of CTS symptoms.[6] The injections are
done under local anesthesia.[66][67] This
treatment is not appropriate for extended
periods, however. In general, local steroid
injections are only used until more
definitive treatment options can be used.
Corticosteroid injections do not appear
to be very effective for slowing disease
progression.[6]

Surgery
Carpal tunnel syndrome operation

Release of the transverse carpal

ligament is known as "carpal tunnel
release" surgery. It is recommended
when there is static (constant, not just
intermittent) numbness, muscle
weakness, or atrophy, and when night-
splinting or other conservative
interventions no longer control
intermittent symptoms.[68] The surgery
may be done with local[69][70][71] or
regional anesthesia[72] with[73] or
without[70] sedation, or under general
anesthesia.[71][72] In general, milder cases
can be controlled for months to years,
but severe cases are unrelenting
symptomatically and are likely to result in
surgical treatment.[74]

Surgery is more beneficial in the short

term to alleviate symptoms (up to six
months) than wearing an orthosis for a
minimum of 6 weeks. However, surgery
and wearing a brace resulted in similar
symptom relief in the long term (12–18
month outcomes).[75]

Physical therapy

A recent evidence based guideline

produced by the American Academy of
Orthopedic Surgeons assigned various
grades of recommendation to
physiotherapy (also called physical
therapy) and other nonsurgical
treatments.[76] One of the primary issues
with physiotherapy is that it attempts to
reverse (often) years of pathology inside
the carpal tunnel. Practitioners caution
that any physiotherapy such as
myofascial release may take weeks of
persistent application to effectively
manage carpal tunnel syndrome.[77]

Again, some claim that pro-active ways

to reduce stress on the wrists, which
alleviates wrist pain and strain, involve
adopting a more ergonomic work and life
environment. For example, some have
claimed that switching from a QWERTY
computer keyboard layout to a more
optimised ergonomic layout such as
Dvorak was commonly cited as beneficial
in early CTS studies; however, some
meta-analyses of these studies claim
that the evidence that they present is
limited.[78][79]

Prognosis

Scars from carpal tunnel release surgery. Two

different techniques were used. The left scar is 6
weeks old, the right scar is 2 weeks old. Also note
the muscular atrophy of the thenar eminence in the
left hand, a common sign of advanced CTS
Most people relieved of their carpal
tunnel symptoms with conservative or
surgical management find minimal
residual or "nerve damage".[80] Long-term
chronic carpal tunnel syndrome (typically
seen in the elderly) can result in
permanent "nerve damage", i.e.
irreversible numbness, muscle wasting,
and weakness. Those that undergo a
carpal tunnel release are nearly twice as
likely as those not having surgery to
develop trigger thumb in the months
following the procedure.[81]

While outcomes are generally good,

certain factors can contribute to poorer
results that have little to do with nerves,
anatomy, or surgery type. One study
showed that mental status parameters or
alcohol use yields much poorer overall
results of treatment.[82]

Recurrence of carpal tunnel syndrome

after successful surgery is rare.[83]

Epidemiology

Rates of carpal tunnel syndrome by ethnicity. CTS is

much more common in Caucasians.
Carpal tunnel syndrome is estimated to
affect one out of ten people during their
lifetime and is the most common nerve
compression syndrome.[6] It accounts for
about 90% of all nerve compression
syndromes.[84] In the U.S., 5% of people
have the effects of carpal tunnel
syndrome. Caucasians have the highest
risk of CTS compared with other races
such as non-white South Africans.[85]
Women suffer more from CTS than men
with a ratio of 3:1 between the ages of
45–60 years. Only 10% of reported cases
of CTS are younger than 30 years.[85]
Increasing age is a risk factor. CTS is
also common in pregnancy.[6]
Occupational

As of 2010, 8% of U.S. workers reported

ever having carpal tunnel syndrome and
4% reported carpal tunnel syndrome in
the past 12 months. Prevalence rates for
carpal tunnel syndrome in the past 12
months were higher among females than
among males; among workers aged 45–
64 than among those aged 18–44.
Overall, 67% of current carpal tunnel
syndrome cases among current/recent
workers were reportedly attributed to
work by health professionals, indicating
that the prevalence rate of work-related
carpal tunnel syndrome among workers
was 2%, and that there were
approximately 3.1 million cases of work-
related carpal tunnel syndrome among
U.S. workers in 2010. Among current
carpal tunnel syndrome cases attributed
to specific jobs, 24% were attributed to
jobs in the manufacturing industry, a
proportion 2.5 times higher than the
proportion of current/recent workers
employed in the manufacturing industry,
suggesting that jobs in this industry are
associated with an increased risk of
work-related carpal tunnel syndrome.[86]

History
The condition known as carpal tunnel
syndrome had major appearances
throughout the years but it was most
commonly heard of in the years following
World War II.[8] Individuals who had
suffered from this condition have been
depicted in surgical literature for the mid-
19th century.[8] In 1854, Sir James Paget
was the first to report median nerve
compression at the wrist in two
cases.[87][88]

The first to notice the association

between the carpal ligament pathology
and median nerve compression appear
to have been Pierre Marie and Charles
Foix in 1913.[89] They described the
results of a postmortem of an 80-year-
old man with bilateral carpal tunnel
syndrome. They suggested that division
of the carpal ligament would be curative
in such cases. Putman had previously
described a series of 37 patients and
suggested a vasomotor origin.[90] The
association between the thenar muscle
atrophy and compression was noted in
1914.[91] The name 'carpal tunnel
syndrome' appears to have been coined
by Moersch in 1938.[92]

In the early 20th century there were

various cases of median nerve
compression underneath the transverse
carpal ligament.[88] Physician Dr. George
S. Phalen of the Cleveland Clinic
identified the pathology after working
with a group of patients in the 1950s and
1960s.[93][94]

Treatment

Paget described two cases of carpal

tunnel syndrome. The first was due to an
injury where a cord had been wrapped
around a man's wrist. The second was
due to a distal radial fracture. For the first
case Paget performed an amputation of
the hand. For the second case Paget
recommended a wrist splint – a
treatment that is still in use today.
Surgery for this condition initially
involved the removal of cervical ribs
despite Marie and Foix's suggested
treatment. In 1933 Sir James Learmonth
outlined a method of decompression of
the nerve at the wrist.[95] This procedure
appears to have been pioneered by the
Canadian surgeons Herbert Galloway
and Andrew MacKinnon in 1924 in
Winnipeg but was not published.[96]
Endoscopic release was described in
1988.[97]

See also
Repetitive strain injury
Tarsal tunnel syndrome
Ulnar nerve entrapment

References
1. Burton, C; Chesterton, LS; Davenport, G
(May 2014). "Diagnosing and managing
carpal tunnel syndrome in primary care" .
The British Journal of General Practice :
The Journal of the Royal College of
General Practitioners. 64 (622): 262–3.
doi:10.3399/bjgp14x679903 .
PMC 4001168 . PMID 24771836 .
2. "Carpal Tunnel Syndrome Fact Sheet" .
National Institute of Neurological
Disorders and Stroke. January 28, 2016.
Archived from the original on 3 March
2016. Retrieved 4 March 2016.
3. American Academy of Orthopaedic
Surgeons (February 29, 2016).
"Management of Carpal Tunnel Syndrome
Evidence-Based Clinical Practice
Guideline" .
4. Osterman, M; Ilyas, AM; Matzon, JL
(October 2012). "Carpal tunnel syndrome
in pregnancy". The Orthopedic Clinics of
North America. 43 (4): 515–20.
doi:10.1016/j.ocl.2012.07.020 .
PMID 23026467 .
5. Bickel, KD (January 2010). "Carpal
tunnel syndrome". The Journal of Hand
Surgery. 35 (1): 147–52.
doi:10.1016/j.jhsa.2009.11.003 .
PMID 20117319 .
6. Padua, L; Coraci, D; Erra, C; Pazzaglia, C;
Paolasso, I; Loreti, C; Caliandro, P;
Hobson-Webb, LD (November 2016).
"Carpal tunnel syndrome: clinical features,
diagnosis, and management". Lancet
Neurology (Review). 15 (12): 1273–84.
doi:10.1016/S1474-4422(16)30231-9 .
PMID 27751557 .
7. Shiri, R (December 2014).
"Hypothyroidism and carpal tunnel
syndrome: a meta-analysis". Muscle &
Nerve. 50 (6): 879–83.
doi:10.1002/mus.24453 .
PMID 25204641 .
8. Amadio, Peter C. (2007). "History of
carpal tunnel syndrome" . In Luchetti,
Riccardo; Amadio, Peter C. Carpal Tunnel
Syndrome. Berlin: Springer. pp. 3–9.
ISBN 978-3-540-22387-0.
9. "Carpal tunnel syndrome – Symptoms" .
NHS Choices. Archived from the original
on 2016-05-24. Retrieved 2016-05-21.
Page last reviewed: 18/09/2014
10. Atroshi, I.; Gummesson, C; Johnsson,
R; Ornstein, E; Ranstam, J; Rosén, I (1999).
"Prevalence of Carpal Tunnel Syndrome in
a General Population". JAMA. 282 (2):
153–158. doi:10.1001/jama.282.2.153 .
PMID 10411196 .
11. "Carpal Tunnel Syndrome Information
Page" . National Institute of Neurological
Disorders and Stroke. December 28, 2010.
Archived from the original on December
22, 2010.
12. Netter, Frank (2011). Atlas of Human
Anatomy (5th ed.). Philadelphia, PA:
Saunders Elsevier. pp. 412, 417, 435.
ISBN 978-0-8089-2423-4.
13. Sternbach, G (1999). "The carpal
tunnel syndrome". Journal of Emergency
Medicine. 17 (3): 519–23.
doi:10.1016/S0736-4679(99)00030-X .
PMID 10338251 .
14. Katz, Jeffrey N.; Simmons, Barry P.
(2002). "Carpal Tunnel Syndrome". New
England Journal of Medicine. 346 (23):
1807–12. doi:10.1056/NEJMcp013018 .
PMID 12050342 .
15. "Carpal Tunnel Syndrome" . American
Academy of Orthopaedic Surgeons.
December 2009. Archived from the
original on 2011-09-27.
16. Tiong, W. H. C.; Ismael, T.; Regan, P. J.
(2005). "Two rare causes of carpal tunnel
syndrome". Irish Journal of Medical
Science. 174 (3): 70–8.
doi:10.1007/BF03170208 .
PMID 16285343 .
17. Conceição, I; González-Duarte, A;
Obici, L; Schmidt, HH; Simoneau, D; Ong,
ML; Amass, L (March 2016). " "Red-flag"
symptom clusters in transthyretin familial
amyloid polyneuropathy" . Journal of the
Peripheral Nervous System : JPNS. 21 (1):
5–9. doi:10.1111/jns.12153 .
PMC 4788142 . PMID 26663427 .
18. Ibrahim I.; Khan W. S.; Goddard N.;
Smitham P. (2012). "Suppl 1: Carpal
Tunnel Syndrome: A Review of the Recent
Literature" . The Open Orthopaedics
Journal. 6: 69–76.
doi:10.2174/1874325001206010069 .
PMC 3314870 . PMID 22470412 .
19. Armstrong T., Chaffin D. (1979).
"Capral tunnel syndrome and selected
personal attributes". Journal of
Occupational Medicine. 21 (7).
20. Schuind F.; Ventura M.; Pasteels J.
(1990). "Idiopathic carpal tunnel
syndrome: Histologic study of flexor
tendon synovium". The Journal of Hand
Surgery. 15 (3): 497–503.
doi:10.1016/0363-5023(90)90070-8 .
PMID 2348074 .
21. Derebery, J (2006). "Work-related
carpal tunnel syndrome: the facts and the
myths". Clinics in Occupational and
Environmental Medicine. 5 (2): 353–67,
viii. doi:10.1016/j.coem.2005.11.014
(inactive 2018-09-04). PMID 16647653 .
22. Office of Communications and Public
Liaison (December 18, 2009). "National
Institute of Neurological Disorders and
Stroke" . Archived from the original on
March 3, 2016.
23. Werner, Robert A. (2006). "Evaluation
of Work-Related Carpal Tunnel Syndrome".
Journal of Occupational Rehabilitation. 16
(2): 201–16. doi:10.1007/s10926-006-
9026-3 . PMID 16705490 .
24. Graham, B. (1 December 2008). "The
Value Added by Electrodiagnostic Testing
in the Diagnosis of Carpal Tunnel
Syndrome". The Journal of Bone and Joint
Surgery. 90 (12): 2587–2593.
doi:10.2106/JBJS.G.01362 .
PMID 19047703 .
25. Cole, Donald C.; Hogg-Johnson,
Sheilah; Manno, Michael; Ibrahim,
Selahadin; Wells, Richard P.; Ferrier, Sue E.;
Worksite Upper Extremity Research Group
(2006). "Reducing musculoskeletal burden
through ergonomic program
implementation in a large newspaper".
International Archives of Occupational and
Environmental Health. 80 (2): 98–108.
doi:10.1007/s00420-006-0107-6 .
PMID 16736193 .
26. Luckhaupt, Sara E.; Burris, Dara L. (24
June 2013). "How Does Work Affect the
Health of the U.S. Population? Free Data
from the 2010 NHIS-OHS Provides the
Answers" . National Institute for
Occupational Safety and Health. Archived
from the original on 18 January 2015.
Retrieved 18 January 2015.
27. Swanson, Naomi; Tisdale-Pardi, Julie;
MacDonald, Leslie; Tiesman, Hope M. (13
May 2013). "Women's Health at Work" .
National Institute for Occupational Safety
and Health. Archived from the original on
18 January 2015. Retrieved 21 January
2015.
28. LOZANOCALDERON, S; PAIVA, A; RING,
D (1 March 2008). "Patient Satisfaction
After Open Carpal Tunnel Release
Correlates With Depression". The Journal
of Hand Surgery. 33 (3): 303–307.
doi:10.1016/j.jhsa.2007.11.025 .
PMID 18343281 .
29. LOZANOCALDERON, S; ANTHONY, S;
RING, D (1 April 2008). "The Quality and
Strength of Evidence for Etiology: Example
of Carpal Tunnel Syndrome". The Journal
of Hand Surgery. 33 (4): 525–538.
doi:10.1016/j.jhsa.2008.01.004 .
PMID 18406957 .
30. Scott, Kevin R.; Kothari, Milind J.
(October 5, 2009). "Treatment of carpal
tunnel syndrome" . UpToDate.
31. Stevens JC, Beard CM, O'Fallon WM,
Kurland LT (1992). "Conditions associated
with carpal tunnel syndrome". Mayo Clin
Proc. 67 (6): 541–548.
doi:10.1016/S0025-6196(12)60461-3 .
PMID 1434881 .
32. "Carpel Tunnel Syndrome in
Acromegaly" .
Treatmentandsymptoms.com. Archived
from the original on 2016-01-26. Retrieved
2011-10-05.
33. Werner, Robert A.; Albers, James W.;
Franzblau, Alfred; Armstrong, Thomas J.
(1994). "The relationship between body
mass index and the diagnosis of carpal
tunnel syndrome". Muscle & Nerve. 17 (6):
632–6. doi:10.1002/mus.880170610 .
PMID 8196706 .
34. Wilbourn AJ, Gilliatt RW (1997).
"Double-crush syndrome: a critical
analysis". Neurology. 49 (1): 21–27.
doi:10.1212/WNL.49.1.21 .
PMID 9222165 .
35. Lupski, James R.; Reid, Jeffrey G.;
Gonzaga-Jauregui, Claudia; Rio Deiros,
David; Chen, David C.Y.; Nazareth, Lynne;
Bainbridge, Matthew; Dinh, Huyen; et al.
(2010). "Whole-Genome Sequencing in a
Patient with Charcot–Marie–Tooth
Neuropathy" . New England Journal of
Medicine. 362 (13): 1181–91.
doi:10.1056/NEJMoa0908094 .
PMC 4036802 . PMID 20220177 .
36. Brooks, JJ; Schiller, JR; Allen, SD;
Akelman, E (Oct 2003). "Biomechanical
and anatomical consequences of carpal
tunnel release". Clinical Biomechanics
(Bristol, Avon). 18 (8): 685–93.
doi:10.1016/S0268-0033(03)00052-4 .
PMID 12957554 .
37. Vella, JC; Hartigan, BJ; Stern, PJ (Jul–
Aug 2006). "Kaplan's cardinal line". The
Journal of Hand Surgery. 31 (6): 912–8.
doi:10.1016/j.jhsa.2006.03.009 .
PMID 16843150 .
38. RH Gelberman; PT Hergenroeder; AR
Hargens; GN Lundborg; WH Akeson (1
March 1981). "The carpal tunnel
syndrome. A study of carpal canal
pressures" . The Journal of Bone and
Joint Surgery. 63 (3): 380–383.
PMID 7204435 . Archived from the
original on 22 March 2009.
39. Norvell, Jeffrey G.; Steele, Mark
(September 10, 2009). "Carpal Tunnel
Syndrome" . eMedicine. Archived from
the original on August 3, 2010.
40. Rempel, D; Evanoff B; Amadio PC; et
al. (1998). "Consensus criteria for the
classification of carpal tunnel syndrome in
epidemiologic studies" . Am J Public
Health. 88 (10): 1447–1451.
doi:10.2105/AJPH.88.10.1447 .
PMC 1508472 . PMID 9772842 .
41. Graham, B; Regehr G; Naglie G; Wright
JG (2006). "Development and validation of
diagnostic criteria for carpal tunnel
syndrome". Journal of Hand Surgery. 31A
(6): 919–924.
42. Cush JJ, Lipsky PE (2004). "Approach
to articular and musculoskeletal
disorders". Harrison's Principles of Internal
Medicine (16th ed.). McGraw-Hill
Professional. p. 2035. ISBN 978-0-07-
140235-4.
43. Gonzalezdelpino, J; Delgadomartinez,
A; Gonzalezgonzalez, I; Lovic, A (1997).
"Value of the carpal compression test in
the diagnosis of carpal tunnel syndrome".
The Journal of Hand Surgery: Journal of
the British Society for Surgery of the Hand.
22: 38–41. doi:10.1016/S0266-
7681(97)80012-5 .
44. Durkan, JA (1991). "A new diagnostic
test for carpal tunnel syndrome". The
Journal of Bone and Joint Surgery.
American Volume. 73 (4): 535–8.
doi:10.2106/00004623-199173040-
00009 . PMID 1796937 .
45. Ma H, Kim I (November 2012). "The
diagnostic assessment of hand elevation
test in carpal tunnel syndrome" . Journal
of Korean Neurosurgical Society. 52 (5):
472–5. doi:10.3340/jkns.2012.52.5.472 .
PMC 3539082 . PMID 23323168 .
46. Netter, Frank (2011). Atlas of Human
Anatomy (5th ed.). Philadelphia, PA:
Saunders Elsevier. p. 447. ISBN 978-0-
8089-2423-4.
47. Robinson, L (2007). "Electrodiagnosis
of Carpal Tunnel Syndrome". Physical
Medicine and Rehabilitation Clinics of
North America. 18 (4): 733–46.
doi:10.1016/j.pmr.2007.07.008 .
PMID 17967362 .
48. Wilder-Smith, Einar P; Seet, Raymond
C S; Lim, Erle C H (2006). "Diagnosing
carpal tunnel syndrome—clinical criteria
and ancillary tests". Nature Clinical
Practice Neurology. 2 (7): 366–74.
doi:10.1038/ncpneuro0216 .
PMID 16932587 .
49. Bland, Jeremy DP (2005). "Carpal
tunnel syndrome". Current Opinion in
Neurology. 18 (5): 581–5.
doi:10.1097/01.wco.0000173142.58068.
5a . PMID 16155444 .
50. Jarvik, J; Yuen, E; Kliot, M (2004).
"Diagnosis of carpal tunnel syndrome:
electrodiagnostic and MR imaging
evaluation". Neuroimaging Clinics of North
America. 14 (1): 93–102, viii.
doi:10.1016/j.nic.2004.02.002 .
PMID 15177259 .
51. Spooner, GR; Desai, HB; Angel, JF;
Reeder, BA; Donat, JR (Oct 1993). "Using
pyridoxine to treat carpal tunnel
syndrome. Randomized control trial" .
Canadian Family Physician. 39: 2122–7.
PMC 2379872 . PMID 8219859 .
52. Scangas, G; Lozano-Calderón, S; Ring,
D (Sep 2008). "Disparity between popular
(Internet) and scientific illness concepts of
carpal tunnel syndrome causation". The
Journal of Hand Surgery. 33 (7): 1076–80.
doi:10.1016/j.jhsa.2008.03.001 .
PMID 18762100 .
53. Lozano-Calderón, Santiago; Shawn
Anthony; David Ring (April 2008). "The
Quality and Strength of Evidence for
Etiology: Example of Carpal Tunnel
Syndrome". The Journal of Hand Surgery.
33 (4): 525–538.
doi:10.1016/j.jhsa.2008.01.004 .
PMID 18406957 .
54. "Wrist Rests : OSH Answers" .
Canadian Centre for Occupational Health
and Safety. Archived from the original on
2017-04-15. Retrieved 2017-04-14.
55. Goodman, G (2014-12-08). Ergonomic
interventions for computer users with
cumulative trauma disorders. International
handbook of occupational therapy
interventions. 2nd ed. pp. 205–17.
ISBN 978-3-319-08140-3.
56. Kalliainen, Loree K. (2017).
"Nonoperative Options for the
Management of Carpal Tunnel Syndrome".
Carpal Tunnel Syndrome and Related
Median Neuropathies. Springer, Cham.
pp. 109–124. doi:10.1007/978-3-319-
57010-5_11 . ISBN 9783319570082.
57. "Nadal, Roger, and Susan Lintsworth.
"Getting a Hand up on Carpal Tunnel
Syndrome. Tips for Beating the Malady of
the Information Age." PTA Today. EBSCO
Host, Apr. 2002. Web. 24 Jan. 2014.
"Archived copy" (PDF). Archived (PDF)
from the original on 2014-02-28. Retrieved
2014-02-27."
58. Piazzini, DB; Aprile, I; Ferrara, PE;
Bertolini, C; Tonali, P; Maggi, L; Rabini, A;
Piantelli, S; Padua, L (Apr 2007). "A
systematic review of conservative
treatment of carpal tunnel syndrome".
Clinical Rehabilitation. 21 (4): 299–314.
doi:10.1177/0269215507077294 .
PMID 17613571 .
59. Clinical Practice Guideline on the
Treatment of Carpal Tunnel Syndrome
(PDF). American Academy of Orthopaedic
Surgeons. September 2008. Archived
(PDF) from the original on 2009-12-11.

60. American Academy of Neurology

(2006). "Quality Standards Subcommittee:
Practice parameter for carpal tunnel
syndrome". Neurology. 43 (11): 2406–
2409. doi:10.1212/wnl.43.11.2406 .
PMID 8232968 .
61. Katz, Jeffrey N.; Simmons, Barry P.
(2002). "Carpal Tunnel Syndrome". New
England Journal of Medicine. 346 (23):
1807–1812.
doi:10.1056/NEJMcp013018 .
PMID 12050342 .
62. Harris JS, ed. (1998). Occupational
Medicine Practice Guidelines: evaluation
and management of common health
problems and functional recovery in
workers. Beverly Farms, Mass.: OEM
Press. ISBN 978-1-883595-26-5.
63. Premoselli, S; Sioli, P; Grossi, A; Cerri,
C (2006). "Neutral wrist splinting in carpal
tunnel syndrome: a 3- and 6-months
clinical and neurophysiologic follow-up
evaluation of night-only splint therapy".
Europa Medicophysica. 42 (2): 121–6.
PMID 16767058 .
64. Michlovitz, SL (2004). "Conservative
interventions for carpal tunnel syndrome".
The Journal of Orthopaedic and Sports
Physical Therapy. 34 (10): 589–600.
doi:10.2519/jospt.2004.34.10.589 .
PMID 15552705 .
65. Marshall, Shawn C; Tardif, Gaetan;
Ashworth, Nigel L; Marshall, Shawn C
(2007). Marshall, Shawn C, ed. "Local
corticosteroid injection for carpal tunnel
syndrome". Cochrane Database of
Systematic Reviews (2): CD001554.
doi:10.1002/14651858.CD001554.pub2 .
PMID 17443508 .
66. "Carpal Tunnel Steroid Injection" .
Medscape. Archived from the original on
July 29, 2015. Retrieved July 9, 2015.
67. "Carpal Tunnel Injection Information" .
EBSCO. Archived from the original on
2015-07-10 – via The Mount Sinai
Hospital.
68. Hui, A.C.F.; Wong, S.M.; Tang, A.; Mok,
V.; Hung, L.K.; Wong, K.S. (2004). "Long-
term outcome of carpal tunnel syndrome
after conservative treatment".
International Journal of Clinical Practice.
58 (4): 337–9. doi:10.1111/j.1368-
5031.2004.00028.x . PMID 15161116 .
69. "Open Carpal Tunnel Surgery for
Carpal Tunnel Syndrome" . WebMD.
Archived from the original on July 7,
2015. Retrieved July 9, 2015.
70. al Youha, Sarah; Lalonde, Donald (May
2014). "Update/Review: Changing of Use
of Local Anesthesia in the Hand" . Plastic
and Reconstructive Surgery Global Open.
2 (5): e150.
doi:10.1097/GOX.0000000000000095 .
PMC 4174079 . PMID 25289343 .
71. Nabhan A, Ishak B, Al-Khayat J,
Steudel W-I (April 25, 2008). "Endoscopic
Carpal Tunnel Release using a modified
application technique of local anesthesia:
safety and effectiveness" . Journal of
Brachial Plexus and Peripheral Nerve
Injury. 3 (11): e35–e38. doi:10.1186/1749-
7221-3-11 . PMC 2383895 .
PMID 18439257 .
72. "AAOS Informed Patient Tutorial –
Carpal Tunnel Release Surgery" . The
American Academy of Orthopaedic
Surgeons. Archived from the original on
July 19, 2015. Retrieved July 9, 2015.
73. Lee J-J, Hwang SM, Jang JS, Lim SY,
Heo D-H, Cho YJ (2010). "Remifentanil-
Propofol Sedation as an Ambulatory
Anesthesia for Carpal Tunnel Release"
(PDF). Journal of Korean Neurosurgical
Society. 48 (5): 429–433.
doi:10.3340/jkns.2010.48.5.429 .
PMC 3030083 . PMID 21286480 .
Archived (PDF) from the original on 2017-
09-08.
74. Kouyoumdjian, JA; Morita, MP; Molina,
AF; Zanetta, DM; Sato, AK; Rocha, CE;
Fasanella, CC (2003). "Long-term
outcomes of symptomatic
electrodiagnosed carpal tunnel
syndrome". Arquivos de Neuro-psiquiatria.
61 (2A): 194–8. doi:10.1590/S0004-
282X2003000200007 . PMID 12806496 .
75. D'Angelo, Kevin; Sutton, Deborah; Côté,
Pierre; Dion, Sarah; Wong, Jessica J.; Yu,
Hainan; Randhawa, Kristi; Southerst,
Danielle; Varatharajan, Sharanya (2015).
"The Effectiveness of Passive Physical
Modalities for the Management of Soft
Tissue Injuries and Neuropathies of the
Wrist and Hand: A Systematic Review by
the Ontario Protocol for Traffic Injury
Management (OPTIMa) Collaboration" .
Journal of Manipulative and Physiological
Therapeutics. 38 (7): 493–506.
doi:10.1016/j.jmpt.2015.06.006 .
PMID 26303967 .
76. Keith, M. W.; Masear, V.; Chung, K. C.;
Amadio, P. C.; Andary, M.; Barth, R. W.;
Maupin, K.; Graham, B.; Watters, W. C.;
Turkelson, C. M.; Haralson, R. H.; Wies, J.
L.; McGowan, R. (4 January 2010).
"American Academy of Orthopaedic
Surgeons Clinical Practice Guideline on
The Treatment of Carpal Tunnel
Syndrome". The Journal of Bone and Joint
Surgery. 92 (1): 218–219.
doi:10.2106/JBJS.I.00642 .
PMID 20048116 .
77. Siu, G.; Jaffee, J.D.; Rafique, M.;
Weinik, M.M. (1 March 2012).
"Osteopathic Manipulative Medicine for
Carpal Tunnel Syndrome". The Journal of
the American Osteopathic Association.
112 (3): 127–139. PMID 22411967 .
78. Lincoln, A; Vernick, JS; Ogaitis, S;
Smith, GS; Mitchell, CS; Agnew, J (2000).
"Interventions for the primary prevention
of work-related carpal tunnel syndrome".
American Journal of Preventive Medicine.
18 (4 Suppl): 37–50. doi:10.1016/S0749-
3797(00)00140-9 . PMID 10793280 .
79. Verhagen, Arianne P; Karels, Celinde C;
Bierma-Zeinstra, Sita MA; Burdorf, Lex L;
Feleus, Anita; Dahaghin, Saede SD; De Vet,
Henrica CW; Koes, Bart W; Verhagen,
Arianne P (2006). Verhagen, Arianne P, ed.
"Ergonomic and physiotherapeutic
interventions for treating work-related
complaints of the arm, neck or shoulder in
adults". Cochrane Database of Systematic
Reviews. 3 (3): CD003471.
doi:10.1002/14651858.CD003471.pub3 .
PMID 16856010 .
80. Olsen, K. M.; Knudson, D. V. (2001).
"Change in Strength and Dexterity after
Open Carpal Tunnel Release". International
Journal of Sports Medicine. 22 (4): 301–3.
doi:10.1055/s-2001-13815 .
PMID 11414675 .
81. King, Bradley A.; Stern, Peter J.;
Kiefhaber, Thomas R. (2013). "The
incidence of trigger finger or de Quervain's
tendinitis after carpal tunnel release".
Journal of Hand Surgery (European
Volume). 38 (1): 82–3.
doi:10.1177/1753193412453424 .
PMID 22791612 .
82. Katz, Jeffrey N.; Losina, Elena; Amick,
Benjamin C.; Fossel, Anne H.; Bessette,
Louis; Keller, Robert B. (2001). "Predictors
of outcomes of carpal tunnel release".
Arthritis & Rheumatism. 44 (5): 1184–93.
doi:10.1002/1529-
0131(200105)44:5<1184::AID-
ANR202>3.0.CO;2-A .
83. Ruch, DS; Seal, CN; Bliss, MS; Smith,
BP (2002). "Carpal tunnel release: efficacy
and recurrence rate after a limited incision
release". Journal of the Southern
Orthopaedic Association. 11 (3): 144–7.
PMID 12539938 .
84. Ibrahim I.; Khan W. S.; Goddard N.;
Smitham P. (2012). "Carpal Tunnel
Syndrome: A Review of the Recent
Literature" . The Open Orthopaedics
Journal. 6: 69–76.
doi:10.2174/1874325001206010069 .
PMC 3314870 . PMID 22470412 .
85. Ashworth, Nigel L. (December 4,
2008). "Carpal Tunnel Syndrome" .
eMedicine. Archived from the original on
July 28, 2010.
86. Luckhaupt SE, Dahlhamer JM, Ward
BW, Sweeney MH, Sestito JP, Calvert GM
(June 2013). "Prevalence and work-
relatedness of carpal tunnel syndrome in
the working population, United States,
2010 National Health Interview Survey" .
American Journal of Industrial Medicine.
56 (6): 615–24. doi:10.1002/ajim.22048 .
PMC 4557701 . PMID 22495886 .
87. Paget J (1854) Lectures on surgical
pathology. Lindsay & Blakinston,
Philadelphia
88. Fuller, David A. (September 22, 2010).
"Carpal Tunnel Syndrome" . eMedicine.
Archived from the original on July 27,
2010.
89. Marie P, Foix C (1913). "Atrophie isolée
de l'éminence thenar d'origine névritique:
role du ligament annulaire antérieur du
carpe dans la pathogénie de la lésion". Rev
Neurol. 26: 647–649.
90. Putnam JJ (1880). "A series of cases
of paresthesia, mainly of the hand, or
periodic recurrence, and possibly of vaso-
motor origin". Arch Med. 4: 147–162.
91. Hunt JR (1914). "The neural atrophy of
the muscle of the hand, without sensory
disturbances". Rev Neurol Psych. 12: 137–
148.
92. Moersch FP (1938). "Median thenar
neuritis". Proc Staff Meet Mayo Clin. 13:
220.
93. Phalen GS, Gardner WJ, Lalonde AA
(1950). "Neuropathy of the median nerve
due to compression beneath the
transverse carpal ligament". J Bone Joint
Surg Am. 1: 109–112.
94. Gilliatt RW, Wilson TG (1953). "A
pneumatic-tourniquet test in the carpal-
tunnel syndrome". Lancet. 262 (6786):
595–597. doi:10.1016/s0140-
6736(53)90327-4 .
95. Learmonth JR (1933). "The principle of
decompression in the treatment of certain
diseases of peripheral nerves". Surg Clin
North Am. 13: 905–913.
96. Amadio PC (1995). "The first carpal
tunnel release?". J Hand Surg: British &
European. 20 (1): 40–41.
doi:10.1016/s0266-7681(05)80013-0 .
97. Chow JC (1989). "Endoscopic release
of the carpal tunnel ligament: a new
technique for carpal tunnel syndrome".
Arthroscopy. 6 (4): 288–296.
doi:10.1016/0749-8063(90)90058-l .

External links
Classification ICD-10: G56.0 • D

ICD-9-CM: 354.0 •
OMIM: 115430 •
MeSH: D002349 •
DiseasesDB: 2156

External resources MedlinePlus:

000433 •
eMedicine:
orthoped/455
pmr/21 emerg/83
radio/135

Carpal Tunnel Syndrome Fact Sheet

(National Institute of Neurological
Disorders and Stroke)
NHS website carpal-tunnel.net
provides a free to use, validated, online
self diagnosis questionnaire for CTS
Retrieved from
"https://en.wikipedia.org/w/index.php?
title=Carpal_tunnel_syndrome&oldid=869879493"

Last edited 10 days ago by Smaso…

Content is available under CC BY-SA 3.0 unless

otherwise noted.