Carpal Tunnel Syndrome

Abstract

Carpal Tunnel Syndrome (CTS) is a condition marked by the compression of the median nerve as it passes through the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by bones and ligaments, housing not only the median nerve but also tendons responsible for flexing the fingers and thumb.

The etiology of CTS is complex, stemming from a combination of anatomical, biomechanical, and systemic factors. Anatomically, variations in the size and shape of the carpal tunnel can predispose individuals to nerve compression. Factors such as a smaller tunnel or an enlarged median nerve due to inflammation can increase the risk of compression. Additionally, conditions that cause swelling or inflammation in the wrist, such as arthritis or trauma, can exacerbate nerve compression.

Biomechanical factors also contribute significantly to the development of CTS. Repetitive hand and wrist movements, particularly those involving forceful or prolonged flexion and extension, can lead to increased pressure within the carpal tunnel, further compromising nerve function.

Furthermore, systemic factors such as obesity, diabetes, and hormonal changes (e.g., pregnancy or menopause) participate in CTS development. Understanding and addressing these risk factors are crucial for both preventing and managing CTS. Ergonomic interventions, such as proper wrist positioning and regular rest breaks during repetitive tasks, can help alleviate stress on the median nerve. Additionally, maintaining a healthy weight, managing underlying medical conditions, and avoiding activities that exacerbate symptoms are all essential strategies for reducing the risk of developing CTS or mitigating its severity.

While primary care physicians often play a key role in managing CTS with conservative treatments initially, such as splints or occupational therapy, severe or refractory cases may necessitate referral to a hand surgeon for surgical intervention.

Surgical treatments for CTS have been well-established and are generally considered safe and effective. Procedures such as carpal tunnel release surgery involve cutting the transverse carpal ligament to enlarge the carpal tunnel and alleviate pressure on the median nerve. With advancements in surgical techniques and technology, these procedures are often performed as minimally invasive outpatient surgeries, resulting in quicker recovery times and improved outcomes for patients. This comprehensive approach, encompassing an understanding of anatomy, risk factors, etiology, and pathophysiology is essential for effectively diagnosing, treating, and preventing CTS.