Carpal tunnel syndrome (CTS) due compression of the median nerve by the transverse carpal ligament at the wrist. Frequently, the patient experiences the gradual onset of numbness or “pins and needles” sensation in the hand and fingers. Pain may be present in the hand or wrist. While weakness of the hand or fingers is unusual, people sometimes complain of decreased strength of the grip or they may say that they have been dropping things from their hands. Symptoms may be provoked by movement of the wrist or typing at a keyboard. Some patients describe a worsening of symptoms at night while in bed. Most cases of CTS are spontaneous in onset or related to repetitive wrist movements. Less commonly it may be related to other medical conditions such as acromegaly. In severe cases atrophy of muscles in the hand can be seen.
Treatment of carpal tunnel syndrome is initially conservative, limiting the activities that produce symptoms. A trial of wrist splinting may be effective in some patients when compression of the median nerve is mild. When conservative measures fail or when electrodiagnostic testing (nerve conduction studies or NCV) demonstrates moderate or severe compression of the nerve, surgical treatment may be required. Surgery consists of carpal tunnel release (CTR). In this procedure the transverse carpal ligament which frequently is cut to relieve the pressure on the nerve. This is either performed as an open operation or as a less invasive endoscopic technique. Either procedure is highly thickened, effective at treating the symptoms of CTS.