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Abstract
Carpal tunnel syndrome (CTS) is a common disorder resulting from compression of the median nerve at the wrist CTS is an important cause of functional impairment and pain of the
hand, which presumably results from a compression of the median nerve at the wrist CTS the most commonly encountered entrapment neuropathy with an incidence of 139 per 100,000 person-years or men and 506 per 100,000 person-years for women Carpal tunnel studies performed on normal individuals have demonstrated tunnel pressures of 2-3 mmHg. In affected wrists, tunnel pressures exceed 30 mmHg, a threshold pressure which is known to be associated with nerve damage secondary to capillary congestion. With wrist flexion or extension, intracarpal pressures may exceed 90 mmHg Increased pressure within the compartment causes vascular congestion and ischemia, eventually resulting in leaky capillaries and edema of the epineurium and endoneurium. With continued insult wallerian degeneration, fibroblastic proliferation, and irreversible scarring occur CTS may be idiopathic or secondary to other causes like Colles’ fracture, rheumatoid arthritis, hormonal agents and/or oophorectomy diabetes mellitus. It is also common in occupations with excessive use of hands Patients with CTS may present with a variety of symptoms and signs. Women are affected more often than men. The dominant hand usually is more severely affected, especially in idiopathic cases. Patients complain of wrist and arm pain associated with paresthesias in the hand The pain may be localized to the wrist or may radiate to the forearm, arm or, rarely, the shoulder; the neck is not affected Paresthesias are frequently present in the median nerve distribution. Symptoms often are provoked when either a flexed or extended wrist posture is assumed. Nocturnal paresthesias are particularly common. Patients frequently will awaken from sleep and shake their hands or hold them under warm running water .Weakness of thumb abduction and opposition may develop.followed by frank atrophy of the thenar eminence. Some patients describe difficulty buttoning shirts, opening jars, or turning doorknobs.The sensory examination may disclose hypoesthesia in the median distribution. Sensation over the thenar area is spared because this area is innervated by the palmar cutaneous sensory branch, which arises proximal to the carpal tunnel .