Carpal tunnel syndrome natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Dheeraj Makkar, M.D.[2]

Recurrence of sign and symptoms after surgical or nonsurgical interventions is a possible fact. The most important complications include: Scar formation, nerve damage, vascular injuries, incomplete release of the ligament, wound infections.

hand overuse, particularly with vibrating equipment or frequent computer use

• Symptoms

numbness and tingling in radial 3-1/2 digits clumsiness pain and paresthesias that awaken patient at night

• Physical exam

inspection thenar atrophy Riche-Cannieu anastomosis connects the deep branch of the ulnar nerve to the recurrent motor branch of the median nerve, may have preserved thenar strength and severe CTS self administered hand diagram

• the most specific test (76%) for carpal tunnel syndrome

palpation occasionally tender to palpation over the carpal tunnel (rare)

• provocative tests
• carpal tunnel compression test (Durkan’s test)

is the most sensitive test to diagnose carpal tunnel syndrome performed by pressing thumbs over the carpal tunnel and holding pressure for 30 seconds. onset of pain or paresthesia in the median nerve distribution within 30 seconds is a positive result.

• Phalen test

wrist volar flexion against gravity for ~60 sec produces symptoms less sensitive than Durkan compression test

• Tinel’s test

provocative tests performed by tapping the median nerve over the volar carpal tunnel

• Semmes-Weinstein testing

most sensitive sensory test for detecting early carpal tunnel syndrome measures a single nerve fiber innervating a receptor or group of receptors

• Innervation density test

static and moving two-point discrimination A failure to discriminate two points held 5mm or less apart from one another is a positive test suggestive of CTS measures multiple overlapping of different sensory units and complex cortical integration the test is a good measure for assessing functional nerve regeneration after nerve repair

• CTS-6 Evaluation Tool: a validated clinical tool for diagnosis of CTS.

A score >12 is indicative of 80% probability of CTS. A score of >5 is indicative of 25% probability.

• • CTS-6 Evaluation Tool

Numbness predominantly or exclusively in median nerve territory +3.5 Nocturnal Numbness +4 Thenar atrophy and/or weakness 4/5 weakness or less +5 Positive Phalen test +5 Loss of 2-point discrimination Threshhold of 5mm +4.5 Positive Tinel sign +4

Surgery may cause:

• Scar formation
• Nerve damage
• Vascular injuries
• Incomplete release of the ligament
• Wound infections

Mental status parameters, alcohol usage decrease the final outcome of patients after their therapy.