What causes Carpal Tunnel Syndrome?
Causes may include tenosynovitis (tendon inflammation), rheumatoid arthritis or osteoarthritis, type 1 diabetes, hypothroidism, pregnancy, ganglions, foreign bodies, repetitive motion, carpal fractures or dislocations, or aberrant anatomy. Overall, there a 53 separate causes. Conceptually, the disorder results from increased consents, or from a decreased space, or both.
What are the Symptoms of Carpal Tunnel Syndrome?
These include decreased sensation, paresthesias (abnormal sensations) or tingling in the distribution of the median nerve (see picture); worsened symptoms with repetitive use; night awakening with tingling or numbness; radiation of pain up the forearm; a positive Tinel or Phalen sign with compression at the wrist; and possible thenar muscle wasting causing thumb weakness with advanced cases.
What is the Anatomy of the Carpal Tunnel?
The carpal tunnel is formed by carpal bones (floor), the transverse carpal ligament (roof), the scaphoid and trapezium (radial aspect), and the pisiform and hook of the hamate (ulnar aspect). The tunnel contains 4 FDS tendons, 4 FDP tendons, the FPL tendon and the median nerve (see Picture below)
What is the Surgical Treatment of Carpal Tunnel Compression?
Surgical technique focuses on release of the transverse carpal ligament. Different incisions may be used. These include the standard open approach (shown in the piture), the limited access incision (my personal choice – see picture of the operation) or the endoscopic incision. The main goal is complete release of the ligament without injury to the palmar cutaneous, thenar or main branch of the median nerve. Generally, the result of any of the surgical techniques is exceptional and happy patients are the norm.