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      Carpal Tunnel Syndrome: A Review of the Recent Literature

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          Abstract

          Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging.

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          Prevalence of carpal tunnel syndrome in a general population.

          Isam Atroshi, Jonas Ranstam (1999)
          Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. To estimate the prevalence of CTS in a general population. General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). A region in southern Sweden with a population of 170000. A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.
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            A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.

            Anne Fossel, Michele D Levine, M Koris … (1993)
            We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.
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              Carpal tunnel syndrome: pathophysiology and clinical neurophysiology.

              Robert Werner, Michael Andary (2002)
              Carpal tunnel syndrome (CTS) is a constellation of symptoms associated with compression of the median nerve at the wrist. The pathophysiology of CTS is not fully understood but mechanical aspects of injury within the carpal tunnel are most likely. The issues of ischemia, mechanical trauma, ectopic impulse generation, demyelination, tendonitis, elevated carpal tunnel pressure, mechanical factors, small and large fiber involvement and the variability of symptoms are presented. Documentation of neurophysiologic abnormalities in the median nerve is helpful to establish the diagnosis for CTS. There are several types of clinical neurophysiologic evaluations of the median nerve across the wrist. Sensory and motor nerve conduction studies (NCS) of the median nerve segment across the wrist compared to another nerve segment that does not go through the carpal tunnel (i.e. median, radial, or ulnar) are the most sensitive and accurate techniques. Other neurophysiologic techniques used to document CTS include vibrometry threshold testing, current perception testing, Semmes-Weinstein monofilament testing and two-point discrimination. These techniques have considerable subjective components and have not been found to be as sensitive as traditional NCS.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Orthop J
                Journal ID (iso-abbrev): Open Orthop J
                Journal ID (publisher-id): TOORTHJ
                Title: The Open Orthopaedics Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3250
                Publication date (Electronic): 23 February 2012
                Publication date Collection: 2012
                Volume: 6
                Pages: 69-76
                Affiliations
                [1 ]University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
                [2 ]Department of Trauma & Orthopaedics, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
                Author notes
                [* ]Address correspondence to this author at the University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK; Tel: 02088542300; Fax: 02088542301; E-mail: i.ibrahim@ 123456ucl.ac.uk
                Article
                Publisher ID: TOORTHJ-6-69
                DOI: 10.2174/1874325001206010069
                PMC ID: 3314870
                PubMed ID: 22470412
                SO-VID: 23a5d49d-20ed-4ca1-97ea-d6d9bd23d3f0
                Copyright © © Ibrahim et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 25 September 2011
                Date revision received : 27 October 2011
                Date accepted : 28 October 2011
                Categories
                Subject: Article
                Series title: Suppl 1

                ScienceOpen disciplines: Orthopedics
                Keywords: entrapment neuropathy,carpal tunnel syndrome,median nerve,diagnosis.,pathophysiology
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: entrapment neuropathy, carpal tunnel syndrome, median nerve, diagnosis., pathophysiology

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