Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, characterized by compression of the median nerve as it passes beneath the transverse carpal ligament within the carpal tunnel. This condition is especially prevalent among individuals who perform repetitive hand and wrist motions and can be associated with systemic conditions such as diabetes and rheumatoid arthritis. In orthopaedics, CTS is not only a diagnostic challenge but also a common cause of hand dysfunction that may lead to significant disability if left untreated.
The median nerve is vulnerable to compression in the confined space of the carpal tunnel. Chronic repetitive trauma, inflammatory changes, and anatomical predispositions (such as a relatively smaller carpal tunnel) can increase intracarpal pressure, leading to ischemia of the nerve fibers. Epidemiological studies report a prevalence ranging from 3–5% in the general population, with higher rates among certain occupational groups. Early identification and management are crucial to prevent irreversible nerve damage and subsequent thenar muscle atrophy.
Recent clinical practice guidelines emphasize a staged approach for CTS management. The initial approach is generally conservative and includes:
Activity Modification and Ergonomic Adjustments: Patients are advised to modify repetitive tasks and adopt ergonomic workstations.
Splinting: Night-time wrist splinting is commonly recommended to maintain a neutral wrist position and reduce nocturnal symptoms.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These can provide short-term pain relief.
Corticosteroid Injections: Local injections into the carpal tunnel have been shown to reduce inflammation and are particularly effective in the short term.
Physical Therapy: Techniques such as nerve gliding exercises are frequently incorporated to improve mobility and function.
For patients who do not respond to conservative management within three to six months or who present with severe symptoms (e.g., thenar atrophy, constant pain, and significant weakness), surgical decompression (open or endoscopic carpal tunnel release) is recommended.
Systematic reviews and randomized controlled trials indicate that conservative measures—particularly corticosteroid injections and splinting—offer symptomatic improvement in approximately 60–70% of patients with mild to moderate CTS. For instance, several trials have reported that steroid injections can result in short-term relief (lasting several weeks to months) in nearly 70% of patients, while night splinting has been effective in a comparable proportion. However, the long-term efficacy of these measures may be limited, and many patients eventually require surgical intervention if conservative management fails.
Carpal tunnel syndrome remains a common and challenging condition in orthopaedics. It is characterized by a variety of signs and symptoms—ranging from numbness and tingling to thenar atrophy and decreased grip strength—and can significantly impact daily function. A comprehensive differential diagnosis is essential, as several conditions can mimic CTS. Current treatment guidelines recommend a conservative approach initially, including ergonomic adjustments, splinting, NSAIDs, and corticosteroid injections, with conservative measures providing significant relief (around 60–70% effectiveness) in many cases. For patients with severe or refractory symptoms, surgical decompression remains the
gold standard. Ongoing research and updated clinical guidelines continue to refine the management strategies for this prevalent condition.
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